A nationwide study of conversion from laparoscopic to open cholecystectomy

Edward H. Livingston, Robert V Rege

Research output: Contribution to journalArticle

233 Citations (Scopus)

Abstract

Purpose To determine the national incidence and risk factors for conversion from laparoscopic to open cholecystectomy. Background Most series reporting the rates at which laparoscopic cholecystectomies are performed, relative to the open procedure, have come from centers specializing in laparoscopic surgery. The rates at which conversions occur from these centers may not reflect those in community practice. We sought to determine the actual, and therefore acceptable, conversion rate by examining nationally representative discharge data. Methods The National Hospital Discharge database for 1998 to 2001 was acquired from the Centers for Disease Control. All gallbladder disease related admissions were extracted, and the cholecystectomies (ICD-9-CM codes 51.2X) were analyzed using the SAS package. Stepwise logistic regression was used to determine what factors were associated with the risk of conversion from laparoscopic to open cholecystectomy. Results Approximately 25% of all cholecystectomies are performed by the open technique. Of the remaining 75%, there is an approximately 5% to 10% conversion rate. The major risk factors for conversion included 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. Conclusions 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. The data presented in terms of conversion rates and LOS were derived from population-adjusted hospital discharge data and represent the current U.S. experience for cholecystectomy. From these data the community experience for conversion rates, risk factors, and LOS can be derived.

Original languageEnglish (US)
Pages (from-to)205-211
Number of pages7
JournalAmerican Journal of Surgery
Volume188
Issue number3
DOIs
StatePublished - Sep 2004

Fingerprint

Cholecystectomy
Length of Stay
Cholecystitis
Choledocholithiasis
Obesity
Gallbladder Diseases
Cholelithiasis
Laparoscopic Cholecystectomy
International Classification of Diseases
Centers for Disease Control and Prevention (U.S.)
Laparoscopy
Logistic Models
Databases
Incidence
Population

Keywords

  • Cholecystectomy
  • Cholecystitis
  • Cholelithiasis
  • Complications
  • Length of stay
  • Obesity

ASJC Scopus subject areas

  • Surgery

Cite this

A nationwide study of conversion from laparoscopic to open cholecystectomy. / Livingston, Edward H.; Rege, Robert V.

In: American Journal of Surgery, Vol. 188, No. 3, 09.2004, p. 205-211.

Research output: Contribution to journalArticle

@article{6309ec54e80b4ab8a3332e997aa8c562,
title = "A nationwide study of conversion from laparoscopic to open cholecystectomy",
abstract = "Purpose To determine the national incidence and risk factors for conversion from laparoscopic to open cholecystectomy. Background Most series reporting the rates at which laparoscopic cholecystectomies are performed, relative to the open procedure, have come from centers specializing in laparoscopic surgery. The rates at which conversions occur from these centers may not reflect those in community practice. We sought to determine the actual, and therefore acceptable, conversion rate by examining nationally representative discharge data. Methods The National Hospital Discharge database for 1998 to 2001 was acquired from the Centers for Disease Control. All gallbladder disease related admissions were extracted, and the cholecystectomies (ICD-9-CM codes 51.2X) were analyzed using the SAS package. Stepwise logistic regression was used to determine what factors were associated with the risk of conversion from laparoscopic to open cholecystectomy. Results Approximately 25{\%} of all cholecystectomies are performed by the open technique. Of the remaining 75{\%}, there is an approximately 5{\%} to 10{\%} conversion rate. The major risk factors for conversion included 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. Conclusions 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. The data presented in terms of conversion rates and LOS were derived from population-adjusted hospital discharge data and represent the current U.S. experience for cholecystectomy. From these data the community experience for conversion rates, risk factors, and LOS can be derived.",
keywords = "Cholecystectomy, Cholecystitis, Cholelithiasis, Complications, Length of stay, Obesity",
author = "Livingston, {Edward H.} and Rege, {Robert V}",
year = "2004",
month = "9",
doi = "10.1016/j.amjsurg.2004.06.013",
language = "English (US)",
volume = "188",
pages = "205--211",
journal = "American Journal of Surgery",
issn = "0002-9610",
publisher = "Elsevier Inc.",
number = "3",

}

TY - JOUR

T1 - A nationwide study of conversion from laparoscopic to open cholecystectomy

AU - Livingston, Edward H.

AU - Rege, Robert V

PY - 2004/9

Y1 - 2004/9

N2 - Purpose To determine the national incidence and risk factors for conversion from laparoscopic to open cholecystectomy. Background Most series reporting the rates at which laparoscopic cholecystectomies are performed, relative to the open procedure, have come from centers specializing in laparoscopic surgery. The rates at which conversions occur from these centers may not reflect those in community practice. We sought to determine the actual, and therefore acceptable, conversion rate by examining nationally representative discharge data. Methods The National Hospital Discharge database for 1998 to 2001 was acquired from the Centers for Disease Control. All gallbladder disease related admissions were extracted, and the cholecystectomies (ICD-9-CM codes 51.2X) were analyzed using the SAS package. Stepwise logistic regression was used to determine what factors were associated with the risk of conversion from laparoscopic to open cholecystectomy. Results Approximately 25% of all cholecystectomies are performed by the open technique. Of the remaining 75%, there is an approximately 5% to 10% conversion rate. The major risk factors for conversion included 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. Conclusions 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. The data presented in terms of conversion rates and LOS were derived from population-adjusted hospital discharge data and represent the current U.S. experience for cholecystectomy. From these data the community experience for conversion rates, risk factors, and LOS can be derived.

AB - Purpose To determine the national incidence and risk factors for conversion from laparoscopic to open cholecystectomy. Background Most series reporting the rates at which laparoscopic cholecystectomies are performed, relative to the open procedure, have come from centers specializing in laparoscopic surgery. The rates at which conversions occur from these centers may not reflect those in community practice. We sought to determine the actual, and therefore acceptable, conversion rate by examining nationally representative discharge data. Methods The National Hospital Discharge database for 1998 to 2001 was acquired from the Centers for Disease Control. All gallbladder disease related admissions were extracted, and the cholecystectomies (ICD-9-CM codes 51.2X) were analyzed using the SAS package. Stepwise logistic regression was used to determine what factors were associated with the risk of conversion from laparoscopic to open cholecystectomy. Results Approximately 25% of all cholecystectomies are performed by the open technique. Of the remaining 75%, there is an approximately 5% to 10% conversion rate. The major risk factors for conversion included 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. Conclusions 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. The data presented in terms of conversion rates and LOS were derived from population-adjusted hospital discharge data and represent the current U.S. experience for cholecystectomy. From these data the community experience for conversion rates, risk factors, and LOS can be derived.

KW - Cholecystectomy

KW - Cholecystitis

KW - Cholelithiasis

KW - Complications

KW - Length of stay

KW - Obesity

UR - http://www.scopus.com/inward/record.url?scp=4644262328&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=4644262328&partnerID=8YFLogxK

U2 - 10.1016/j.amjsurg.2004.06.013

DO - 10.1016/j.amjsurg.2004.06.013

M3 - Article

C2 - 15450821

AN - SCOPUS:4644262328

VL - 188

SP - 205

EP - 211

JO - American Journal of Surgery

JF - American Journal of Surgery

SN - 0002-9610

IS - 3

ER -