Preoperative findings predict conversion from laparoscopic to open cholecystectomy.

Area of Science:

• Surgical Oncology
• Gastrointestinal Surgery
• Predictive Analytics in Medicine

Background:

• Conflicting conclusions exist regarding predictive factors for laparoscopic to open cholecystectomy conversion.
• Objective preoperative variables were evaluated to develop a reliable risk score for predicting conversion.

Purpose of the Study:

• To create an accurate and accessible risk score for predicting conversion from laparoscopic to open cholecystectomy.
• To identify objective preoperative variables that independently predict conversion.

Main Methods:

• Retrospective review of 1377 laparoscopic cholecystectomy patients.
• Bivariate and multivariate logistic regression analysis of 70 characteristics.
• Development of a predictive model based on identified independent predictors.

Main Results:

• 8.1% of patients (112/1377) converted to open cholecystectomy.
• Independent predictors identified: male gender, elevated white blood cell count, low serum albumin, pericholecystic fluid, diabetes mellitus, and elevated total bilirubin.
• Predictive model achieved an area under the receiver operator curve of 0.83; risk ranged from 2% to 89% based on factor count.

Conclusions:

• Preoperative parameters can accurately predict conversion to open cholecystectomy.
• Acute cholecystitis increases conversion likelihood, but clinical-pathologic correlation is poor.
• Improved prediction of conversion risk has significant implications for surgical care management.