Conversion after laparoscopic cholecystectomy in England.
BACKGROUND
Laparoscopic cholecystectomy is the procedure of choice for the treatment of symptomatic gallstones. Conversion to open surgery is reported to be necessary in 5-10% of cases. This study aimed to define those factors associated in English hospitals with the need to convert a laparoscopic cholecystectomy to an open procedure. These included patient-related and particularly nonpatient-related factors.


METHODS
Using data derived from a national administrative database, Hospital Episode Statistics, patients undergoing cholecystectomy in acute National Health Service (NHS) hospitals in England during the financial years 2004-2006 were studied. The individual surgeon caseload and the hospital conversion rate were calculated using data from the first (baseline) year. Factors affecting the need for conversion were analyzed using data from the second (index) year.


RESULTS
The study included 43,821 laparoscopic cholecystectomies undertaken from 2005 to 2006 in English hospitals. The overall conversion rate was 5.2%: 4.6% for elective procedures and 9.4% for emergency procedures. Patient-related factors that were good predictors of conversion included male sex, emergency admission, old age, and complicated gallstone disease (p < 0.001). Nonpatient-related factors that were good predictors of conversion included the laparoscopic cholecystectomy caseload of individual consultant surgeons and the overall hospital conversion rate in the previous year (all p < 0.001).


CONCLUSIONS
Conversion after laparoscopic cholecystectomy is less common as consultant caseload increases. This suggests that operation should be undertaken only by surgeons with an adequate caseload. There is a wide variation in conversion rates among hospitals. This has important implications for training as well as for the organization and accreditation of cholecystectomy services on a national basis.
Ballal
M
M
Department of Surgery, Mid Cheshire Hospitals NHS Foundation Trust, Leighton Hospital, Middlewich Road, Crewe, CW1 4QJ, UK.
David
G
G
Willmott
S
S
Corless
D J
DJ
Deakin
M
M
Slavin
J P
JP
D000328:Adult; D000367:Age Factors; D000368:Aged; D016009:Chi-Square Distribution; D017081:Cholecystectomy, Laparoscopic / Q000706:statistics & numerical data*; D002769:Cholelithiasis / Q000601:surgery*; D004739:England; D005260:Female; D006801:Humans; D007813:Laparotomy / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012307:Risk Factors; D012737:Sex Factors; D016896:Treatment Outcome