title: Evaluation of preoperative risk factors for converting laparoscopic to open cholecystectomy.
abstract: Performing laparoscopic cholecystectomy (LC) always carries the risk of having to convert from laparoscopic to open cholecystectomy (LOC). Being able to identify these patients preoperatively may allow better preoperative planning and lowering operative cost. All LC and LOC were performed  by the Eastern Virginia Medical School Department of Surgery retrospectively identified between January 2008 and December 2009. Preoperative risk factors identified in both groups included: age, gender, body mass index greater than 30 kg/m(2), diabetes mellitus, previous upper abdominal  surgery, previous abdominal surgery, presence of pericholecystic fluid, gallbladder wall thickness greater than 3 mm, preoperative diagnosis of acute cholecystitis, and pancreatitis. Reasons for conversion in the LOC group were identified from the operative note. A total of 346 LC and LOC  were identified. The LOC group had 41 identified with a conversion rate of 11.9 per cent. The LOC group was compared with 100 randomly chosen LC. Risk factors that reached statistical significance for conversion included advanced age, male gender, previous upper abdominal surgery, preoperative  diagnosis of acute cholecystitis, and gallbladder wall thickness greater than 3 mm (P = 0.0009). Average operative time was higher in LOC compared with open cholecystectomy (123 minutes average vs 109 minutes average). Of the reasons for conversion, the degree of inflammation  was the most common (51.2%). Preoperative risk factors that were associated with need for conversion were advanced age, male gender, previous upper abdominal surgery, preoperative diagnosis of acute cholecystitis, and pericholecystitic fluid. In patients who have all of these risk factors,  we recommend starting with an open cholecystectomy. This will save operative time and overall cost.
authors.affiliation: Department of Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA. Leenw@evms.edu
authors.forename: Nathan W
authors.initials: NW
authors.lastname: Lee
authors.forename: J
authors.initials: J
authors.lastname: Collins
authors.forename: R
authors.initials: R
authors.lastname: Britt
authors.forename: L D
authors.initials: LD
authors.lastname: Britt
mesh_terms: D000367:Age Factors; D015992:Body Mass Index; D016009:Chi-Square Distribution; D002763:Cholecystectomy; D017081:Cholecystectomy, Laparoscopic; D002764:Cholecystitis / Q000453:epidemiology; D002769:Cholelithiasis / Q000453:epidemiology / Q000601:surgery*; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000453:epidemiology; D010347:Patient Care Planning; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D014768:Virginia / Q000453:epidemiology