Current status of surgical management of acute cholecystitis in the United States.
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.
Csikesz
Nicholas
N
Department of Surgery, Surgical Outcomes Analysis & Research, University of Massachusetts Medical School, 55 Lake Avenue North, S3-838, Worcester, MA 01655, USA.
Ricciardi
Rocco
R
Tseng
Jennifer F
JF
Shah
Shimul A
SA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001649:Bile Duct Diseases / Q000209:etiology; D001652:Bile Ducts / Q000293:injuries; D002648:Child; D002675:Child, Preschool; D002763:Cholecystectomy / Q000009:adverse effects / Q000401:mortality; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000401:mortality; D041881:Cholecystitis, Acute / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D019538:Health Care Surveys; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult