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Objective:
This study examines national trends and associated factors in conversion of laparoscopic to open cholecystectomy in the United States.
Design:
Retrospective Cohort Analysis
Setting and Patients:
Using the National Inpatient Sample, laparoscopic and conversion to open cholecystectomy cases from 2008 and 2009 were selected.
Interventions:
Laparoscopic cholecystectomy or conversion to open cholecystectomy
Main Outcome Measures:
Data analysis included, demographics, hospital variables, comorbidities, length of stay (LOS) and total hospital charges (THC).
Results:
A total of 771,583 cases were identified during the study period: 712,553 (92.3%) laparoscopic cholecystectomy and 61,331 (7.9%) conversion cases. Conversion cases were more likely to be older (median age 60 years vs 50 years, P<0.001), male (49.8% vs 32.5%, P<0.001), and Medicare (42.3% vs 29.2%, P<0.001). Conversion cases resulted in increased median LOS (5 days vs 3 days, P<0.001), increased mean THC ($51,042 vs $38,384, P<0.001), and increased discharge to rehabilitation facilities (10.5% vs 5.1%, P<0.001). Multivariate regression analysis of demographics, disease severity, comorbidities, and hospital variables identified statistical predictors for conversion: male (OR 2.482, P<0.001), congenital biliary abnormalities (OR 4.779, P=0.002), cholangitis (OR 2.119, P=0.011), and obstructive sleep apnea (OR 1.632, P=0.022). Hospital teaching status, size, and urban locations were not statistically significant predictors.
Conclusions:
Laparoscopic to open cholecystectomy conversion carries a significant morbidity and economic burden. Cholangitis or congenital biliary abnormalities in male patients with obstructive sleep apnea are at high risk for conversion to open cholecystectomy.