Dr E Livingston and Dr R Rege from Texas designed a study to determine the national incidence and risk factors associated with conversion from laparoscopic to open cholecystectomy.
Until now, most series reporting the rates at which laparoscopic cholecystectomies are performed, relative to the open procedure, have come from centers specializing in laparoscopic surgery.
As a result, the rates at which conversions occur from these centers may not reflect those in community practice.
The researchers sought to determine the actual conversion rate by examining nationally representative discharge data.
The research group collected data for 1998-2001 from the National Hospital Discharge database acquired from the Centers for Disease Control.
The researchers excluded all gallbladder disease related admissions and the cholecystectomies were analyzed using the SAS package.
Cholecystitis, choledocholithiasis, male sex, and obesity are major predictors for conversion
|American Journal of Surgery|
The research group used stepwise logistic regression was used to determine what factors were associated with the risk of conversion from laparoscopic to open cholecystectomy.
The group found that approximately 25% of all cholecystectomies were performed by the open technique.
In addition, out of the remaining 75%, there was an approximately 5% to 10% conversion rate.
The major risk factors for conversion were found to include male sex, obesity, and cholecystitis.
Concurrent choledocholithiasis, cholelithiasis, and cholecystitis were associated with a conversion rate of 25%.
Length of stay (LOS) was reduced for laparoscopic operations and although conversion added 2 to 3 days to the LOS, for most cases the LOS was still less than for primary open operations.
Dr Rege concluded, "Three quarters of all cholecystectomies are performed laparoscopically, and the national conversion rate is 5% to 10%."
"Cholecystitis, choledocholithiasis, male sex, and obesity are major predictors for conversion."