Steven J Coffin, MSIV1, Peter Callas, PhD1, Sean Wrenn, MD2, Wasef Abu-Jaish, MD, FACS, FASM, BS2. 1University of Vermont College of Medicine, 2University of Vermont Medical Center
Introduction: Recent data suggest a wide range of conversion (4.9%-20%) from laparoscopic to open cholecystectomy (OC) despite increasing surgeon familiarity and superior equipment. Previously identified risk factors for conversion include increased age, male gender, diabetes, and emergent surgeries. Recent studies also suggest that formal minimally invasive surgical training (MIST) reduces conversion rates. We sought to determine conversion rates in our population, a rural-academic medical center, and identify any significant risk factors for conversion.
Methods: We conducted a single-center retrospective review of 2,810 cholecystectomies performed over a seven-year period (2009-2016).
Results: Our study included 837 (29.8%) males and 1973 (71.2%) females with a mean age of 49.2 years. A total of 139 (4.95%) cases were converted to OC. Conversion rates for males, age ≥ 65, and urgent and emergent admissions were statistically significant on univariate analysis. Overall, a total of 1172 (41.7%) cases were performed by surgeons with MIST; of these, 35 (3.0%) were converted to open, as compared to 104 (6.4%) of the 1638 cases performed by surgeons without MIST; this was found to be significant on univariate analysis (p=<0.001). Admit type (p=<0.001), including emergent (p=<0.001) and urgent (p=<0.001) subtypes, male gender (p<0.001), and age ≥ 65 (p=<0.001) were significant on multivariate logistic regression, while the difference by MIST status was no longer significant (p=0.08) in the multivariate analysis.
Conclusion: Our conversion rate from laparoscopic to OC falls within the lower range of recently published literature. This is likely multifactorial, and reflects increasing familiarity of the laparoscopic technique, improved quality of laparoscopic equipment, and/or prior knowledge of preoperative risk factors for conversion. Our results, consistent with previous literature, show a reduced conversion rate amongst surgeons with MIST. This finding, albeit not significant on multivariate analysis, may offer an alterable preoperative risk factor for conversion and warrants further research. Further knowledge about the impact MIST has on conversion may provide a feasible preoperative approach to reducing conversion to OC, thereby reducing costs and overall patient morbidity and mortality.
cholecystectomy, laparoscopic, cholecystitis, conversion, minimally invasive
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79716
Program Number: S005
Presentation Session: Biliary
Presentation Type: Podium