Acute cholecystitis: risk factors for conversion to an open procedure

Area of Science:

• General Surgery
• Surgical Outcomes
• Minimally Invasive Surgery

Background:

• Laparoscopic cholecystectomy is a common procedure, but conversion to open surgery (CTO) increases complications.
• Patients with acute cholecystitis face a higher risk of CTO.
• Previous studies on CTO risk factors in acute cholecystitis are limited by small sample sizes.

Purpose of the Study:

• To identify preoperative variables predicting a higher risk of conversion to open surgery (CTO) in patients undergoing laparoscopic cholecystectomy for acute cholecystitis.

Main Methods:

• Analysis of 7242 patients undergoing laparoscopic cholecystectomy for acute cholecystitis (2005-2011) from the National Surgical Quality Improvement Program database.
• Comparison of demographics, comorbidities, and outcomes between patients who underwent successful laparoscopic surgery and those requiring CTO.
• Multivariable logistic regression to identify independent predictors of CTO.

Main Results:

• Conversion to open surgery (CTO) occurred in 6.0% of patients.
• Patients requiring CTO were older, had a higher body mass index, and more comorbidities.
• CTO was associated with significantly higher rates of mortality, morbidity, reoperation, surgical site infection, and longer hospital stays.
• Independent predictors of CTO included older age, male gender, higher body mass index, elevated alkaline phosphatase and white blood cell count, and lower albumin levels.

Conclusions:

• Conversion to open surgery for acute cholecystitis, while infrequent, is associated with significant adverse outcomes.
• Identified preoperative risk factors can inform clinical decision-making and patient selection for potential delayed interventions.