title: Outcome of laparoscopic cholecystectomy conversion: is the surgeon's selection needed?
abstract: BACKGROUND
  Risk factors for conversion in cholecystectomy may be of clinical value. This study aimed to investigate whether a set of risk factors, including the surgeon's specialization, can be used for the development of a preoperative strategy to optimize conversion outcome.
  
  
  METHODS
  The data for all patients who underwent laparoscopic cholecystectomy at a single institution between January 2004 and December 2008 were retrospectively reviewed. Factors predictive for conversion were identified, and a preoperative strategy model was deduced.
  
  
  RESULTS
  Of the 1,126 patients analyzed, 106 (9%) underwent laparoscopic cholecystectomy in an emergency setting. Delayed surgery was performed for 63 (46%) of 138 patients (12%) with acute cholecystitis. Preoperative endoscopic retrograde cholangiography was achieved for 161 of the patients (14%). Risk factors predictive of conversion (for 65 patients) were male gender [odds ratio (OR), 2.3; 95% confidence interval (CI), 1.3-3.9; p = 0.004], age older than 65 years (OR, 2.6; 95% CI, 1.4-4.8; p = 0.002), body mass index (BMI) exceeding 25 kg/m(2) (OR, 3.4; 95% CI, 1.7-7.1; p < 0.001), history of complicated biliary disease (HCBD) (OR, 5.6; 95% CI, 3.2-9.8; p = < 0.001), and surgery by a non-gastrointestinal (non-GI) surgeon (OR, 4.9; 95% CI, 2.2-10.6; p < 0.001). The conversion rate for patients with a history of no complications who had two or more risk factors (gender, age, BMI > 25) and for patients with a HCBD who had one or more risk factors was significantly higher if the surgery was performed by non-GI rather than GI surgeons.
  
  
  CONCLUSIONS
  Male gender, age older than 65 years, BMI exceeding 25 kg/m(2), HCBD, and surgery by a non-GI surgeon are predictive for conversion. A preoperative triage for surgeon selection based on risk factors and a HCBD is proposed to optimize conversion outcome.
authors.affiliation: Department of Surgery, Onze Lieve Vrouwe Gasthuis (OLVG), 95500, 1090 Amsterdam, HM, The Netherlands. donkpas@wanadoo.nl
authors.forename: Sandra C
authors.initials: SC
authors.lastname: Donkervoort
authors.forename: Lea M
authors.initials: LM
authors.lastname: Dijksman
authors.forename: Lincey C F
authors.initials: LC
authors.lastname: de Nes
authors.forename: Pieter G
authors.initials: PG
authors.lastname: Versluis
authors.forename: Joris
authors.initials: J
authors.lastname: Derksen
authors.forename: Michael F
authors.initials: MF
authors.lastname: Gerhards
mesh_terms: D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002763:Cholecystectomy / Q000379:methods* / Q000706:statistics & numerical data; D017081:Cholecystectomy, Laparoscopic / Q000379:methods / Q000706:statistics & numerical data; D041881:Cholecystitis, Acute / Q000601:surgery*; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D008297:Male; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013038:Specialization / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014218:Triage