Current status of surgical management of acute cholecystitis in the United States
Department of Surgery
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
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.
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Citation: World J Surg. 2008 Oct;32(10):2230-6. Link to article on publisher's site