Evaluation of the conversion rate as it relates to preoperative risk factors and surgeon experience: a retrospective study of 4013 patients undergoing elective laparoscopic cholecystectomy

Abstract

Background Our aim is to determine the relationships among patient demographics, patient history, surgical experience, and conversion rate (CR) during elective laparoscopic cholecystectomies (LCs). Methods We analyzed data from patients who underwent LC surgery between 2005 and 2014 based on patient charts and electronic documentation. CR (%) was evaluated in 4013 patients who underwent elective LC surgery. The relationships between certain predictive factors (patient demographics, endoscopic retrograde cholangiopancreatography (ERCP), acute cholecystitis (AC), abdominal surgery in the patient history, as well as surgical experience) and CR were examined by univariate analysis and logistic regression. Results In our sample (N = 4013), the CR was 4.2%. The CR was twice as frequent among males than among females (6.8 vs. 3.2%, p < 0.001), and the chance of conversion increased from 3.4 to 5.9% in patients older than 65 years. The detected CR was 8.8% in a group of patients who underwent previous ERCP (8.8 vs. 3.5%, p < 0.001). From the ERCP indications, most often, conversion was performed because of severe biliary tract obstruction (CR: 9.3%). LC had to be converted to open surgery after upper and lower abdominal surgeries in 18.8 and 4.8% cases, respectively. Both AC and ERCP in the patient history raised the CR (12.3%, p < 0.001 and 8.8%, p < 0.001). More surgical experience and high surgery volume were not associated with a lower CR prevalence. Conclusions Patient demographics (male gender and age > 65 years), previous ERCP, and upper abdominal surgery or history of AC affected the likelihood of conversion. More surgical experience and high surgery volume were not associated with a lower CR prevalence.

Safe Implementation of a Next-Generation Surgical Robot

“…The rates of conversion to an alternative surgical technique and 90-day mortality rates were low across all surgical indications. The rates of conversion to open surgery reported in this analysis were lower than those reported elsewhere: a conversion rate of 0.6% for robot-assisted cholecystectomy was slightly lower than a rate of 4.2% reported for laparoscopic cholecystectomy; 16 a conversion rate of 6.9% for robot-assisted anterior resection was lower than that of 29% reported for laparoscopic anterior rectal resection; 17 as was the conversion rate of 0.9% for robot-assisted TLH versus 5.0% reported for laparoscopic hysterocolpectomy 18 . The mortality rates reported in this analysis were also lower than or similar to that reported elsewhere: a 90-day mortality rate of 0.6% for robot-assisted cholecystectomy was comparable to operative mortality of 0.5% described for laparoscopic cholecystectomy; 19 a 90-day mortality rate of 0.0% for robot-assisted anterior resection was lower than that of 2.1% reported for laparoscopic resection; 20 a 90-day mortality rate of 0.0% for robot-assisted TLH was similar to reported operative mortality of 1:6814 for laparoscopic and robotic hysterocolpectomy 21 …”

Early laparoscopic cholecystectomy for acute cholecystitis: Does age matter?

“…Several studies, [26][27][28][29] including meta-analyses, 30,31 have been carried out to identify the risk factors of conversion, including patient characteristics, such as sex, comorbidities, history of abdominal surgery and the severity of cholecystitis with the delay of the surgery or gangrene of the gallbladder.…”

Relationship between surgical volume and outcomes in elective and acute cholecystectomy: nationwide, observational study

“…They may be explained by residual confounding related to volume and outcome, or the fact that differences in outcomes after acute surgery are influenced to a greater extent by other factors. Previously published studies [21][22][23][24] have suggested that patient characteristics, such as male sex, age, and previous upper abdominal surgery, or the presence of cholecystitis, have a greater impact on outcomes than the surgeon's operative volume. Although the mortality rate after gallbladder surgery is low, 30-day mortality doubled in hospitals with less extensive volumes.…”