Emergent versus elective cholecystectomy: conversion rates and outcomes.

Area of Science:

• Surgery
• Gastroenterology
• Public Health

Background:

• Laparoscopic cholecystectomy (LC) is standard for gallstones/cholecystitis.
• Conversion rates (CR) to open cholecystectomy (OC) vary, higher in acute cases.
• This study analyzes CR, complications, and outcomes for elective vs. emergency cholecystectomy.

Purpose of the Study:

• To examine conversion rates in a tertiary academic hospital and a statewide quality collaborative.
• To compare complications and outcomes between elective and emergency cholecystectomy.

Main Methods:

• Prospective data from Non-Trauma Emergency Surgery (NTE) and Michigan Surgical Quality Collaborative (MSQC) databases.
• Included emergent cholecystectomies (2008-2009) and a random sample of all operations (2005-2010).
• Compared patient characteristics, CR, and outcomes for emergent versus elective cases.

Main Results:

• Emergency cholecystectomy patients had longer hospital stays (4.9 days vs. 2.65 days).
• Conversion rates were higher in emergent cases (17.5% in NTE, 14.9% in MSQC) compared to elective (9.1% in MSQC).
• Emergency cholecystectomy showed significantly higher morbidity (8.8% vs. 3.7%) and mortality (2.6% vs. 0.5%).

Conclusions:

• Emergency cholecystectomy conversion rates are elevated but below previous high estimates.
• Significant variability exists in emergency cholecystectomy outcomes.
• Further research is needed to identify modifiable factors to improve emergency cholecystectomy outcomes.