Title
Current status of surgical management of acute cholecystitis in the United States
UMMS Affiliation
Department of Surgery
Date
10-1-2008
Document Type
Article
Medical Subject Headings
Adolescent; Adult; Aged; Aged, 80 and over; Bile Duct Diseases; Bile Ducts; Child; Child, Preschool; *Cholecystectomy; Cholecystectomy, Laparoscopic; Cholecystitis, Acute; Female; Health Care Surveys; Hospital Mortality; Humans; Male; Middle Aged; Regression Analysis; Time Factors; United States; Young Adult
Disciplines
Surgery
Abstract
BACKGROUND: We attempted to determine population-based outcomes of laparoscopic (LC) and open cholecystectomy (OC) for acute cholecystitis (AC).
METHODS: We used the National Hospital Discharge Surveys from 2000 through 2005. Annual medical and demographic data from a national sample of discharge records from nonfederal, short-stay hospitals were queried. We identified all patients who underwent LC or OC for AC. The main outcome measures were the rate of LC or OC and in-hospital morbidity and mortality. One million patients underwent cholecystectomy (859,747 LCs; 152,202 OCs) for AC during 2000-2005.
RESULTS: Of the cases started laparoscopically, 9.5% were converted to OC. Compared to OC, patients who underwent LC were more likely to be discharged home (91% vs. 70%), carry private insurance (47% vs. 30%), suffer less morbidity (16% vs. 36%), and have a lower unadjusted mortality (0.4% vs. 3.0%). OC was associated with a 1.3-fold increase (95% confidence interval 1.1-1.4) in perioperative morbidity compared to LC after adjusting for patient and hospital factors.
CONCLUSIONS: Most patients in the 21st century with AC undergo LC with a low conversion rate and low morbidity. In the general population with acute cholecystitis, LC results in lower morbidity and mortality rates than OC even in the setting of open conversion.
Rights and Permissions
Citation: World J Surg. 2008 Oct;32(10):2230-6. Link to article on publisher's site