title: Risk factors for conversion during laparoscopic cholecystectomy - experiences from a general teaching hospital.
abstract: OBJECTIVE
  Laparoscopic cholecystectomy (LC) is the gold standard for treating symptomatic cholelithiasis. Conversion, however, is sometimes necessary. The aim of this study was to determine predictive factors of conversion in patients undergoing LC for various indications in elective and acute settings in a general teaching hospital.
  
  
  METHODS
  A retrospective analysis was performed on 972 consecutive patients who underwent a laparoscopic cholecystectomy in Máxima Medical Centre in Veldhoven, the Netherlands, from January 2000 till January 2006. Recorded data were sex, age, indication for LC, conversion to open cholecystectomy, reason for conversion, performing surgeon, co-morbidity, type of complication, length of hospital stay and 30-day mortality.
  
  
  RESULTS
  Conversion to open cholecystectomy was performed in 121 patients (12%). The most frequent reasons for conversion were infiltration/fibrosis of Calot's triangle (30%) and adhesions (27%). In the multivariate analyses male gender (OR 1.67, 95% CI 1.07-2.59), age >65 years (OR 2.10, 95% CI 1.32-3.34), acute cholecystitis (OR 11.8, 95% CI 6.98-20.1), recent acute cholecystitis (OR 4.71, 95% CI 2.42-9.18) and recent obstructive jaundice (OR 20.6, 95% CI 4.52-94.1) were independent predictive factors for conversion.
  
  
  CONCLUSIONS
  Male gender, age >65 years, (recent) acute cholecystitis and recent obstructive jaundice are independent predictive risk factors for conversion. By appreciating these risk factors for conversion, preoperative patient counselling can be improved.
authors: Department of Surgery, Máxima Medical Centre, Veldhoven, The Netherlands. hjjvandersteeg@hotmail.com
authors: H J J
authors: HJ
authors: van der Steeg
authors: S
authors: S
authors: Alexander
authors: S
authors: S
authors: Houterman
authors: G D
authors: GD
authors: Slooter
authors: R M H
authors: RM
authors: Roumen
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D002763:Cholecystectomy / Q000706:statistics & numerical data; D017081:Cholecystectomy, Laparoscopic / Q000379:methods* / Q000706:statistics & numerical data; D002769:Cholelithiasis / Q000601:surgery*; D015897:Comorbidity; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D018709:Statistics, Nonparametric; D016896:Treatment Outcome