Conversion in laparoscopic cholecystectomy in low versus high-volume hospitals: is there a difference?

Area of Science:

• Surgical Outcomes Research
• Gastrointestinal Surgery
• Health Services Research

Background:

• Laparoscopic cholecystectomy (LC) has become standard, yet conversion rates remain around 5-6% in elective cases and higher for acute cholecystitis.
• Understanding factors influencing conversion rates is crucial for optimizing patient care and surgical training.

Purpose of the Study:

• To investigate the relationship between hospital surgical volume and the conversion rate of laparoscopic cholecystectomy (LC).
• To compare conversion rates between low-volume hospitals (LVHs; ≤100 LC/year) and high-volume hospitals (HVHs; >300 LC/year).

Main Methods:

• Retrospective analysis of cholecystectomy operations performed between 1999 and 2004 in a LVH and a HVH.
• Patients were categorized into primary open cholecystectomy (OC), LC, and conversion (CC) groups.
• Analysis included indications, intraoperative findings, reasons for conversion, and postoperative complications, comparing LVH and HVH data.

Main Results:

• Conversion rates were similar between LVHs (5.3%) and HVHs (5.8%), with no statistically significant difference (P=0.7496).
• Primary reasons for conversion in both settings included dense adhesions, severe cholecystitis, and difficult Calot's triangle anatomy.
• Postoperative complication and reoperation rates did not differ significantly between LVHs and HVHs.

Conclusions:

• Hospital volume does not influence the conversion rate for laparoscopic cholecystectomy.
• The quality of both laparoscopic cholecystectomy and conversion procedures is comparable across low-volume and high-volume hospitals.