title: Emergent versus elective cholecystectomy: conversion rates and outcomes.
abstract: BACKGROUND
  Laparoscopic cholecystectomy (LC) is the procedure of choice for treatment of cholelithiasis/cholecystitis. Conversion rates (CR) to open cholecystectomy (OC) have been reported previously as 5-15% in elective cases, and up to 25% in patients with acute cholecystitis. We examined the CR in a tertiary-care academic hospital and a statewide surgery quality collaborative, and to compare complications and outcomes in elective and emergency cholecystectomy.
  
  
  METHODS
  Prospective data were obtained from: 1) Non-Trauma Emergency Surgery (NTE) database of all emergent cholecystectomies 1/1/2008-12/31/2009; and 2) Michigan Surgical Quality Collaborative (MSQC) database with a random sample of 20-30% of all operations performed 1/1/2005-12/31/2010, including both University of Michigan (UM) data and statewide data from 34 participating hospitals. Patient characteristics, CR, and outcomes were compared for emergent vs. elective cases.
  
  
  RESULTS
  Non-trauma ES patients had a mean hospital length of stay (HLOS) of 4.9 d. Open cholecystectomy-HLOS was greater (4.0, LC; 7.9 laparoscopic converted to open cholecystectomy; 8.7, OC, p<0.0001); mortality was 0.35% and CR was 17.5%. In the UM-MSQC dataset, OC-HLOS was greater (6.8 OC vs. 4.6 LC, p<0.001); mortality was 0.65%; CR was 9.1% in elective cases and 14.9% in emergent cases. CR was almost two-fold higher [17.5% of all NTE cholecystectomies vs. 9.1% of UM-MSQC elective cholecystectomies (p=0.00078)]. The statewide MSQC cholecystectomy data showed significantly increased HLOS in emergent cholecystectomy patients (4.34 vs. 2.65 d; p<0.0001). Morbidity (8.8 vs. 3.7%) and mortality (2.6 vs. 0.5%) rates were also significantly higher in emergent vs. elective cholecystectomies (p<0.0001).
  
  
  CONCLUSIONS
  In NTE patients requiring cholecystectomy, CR is almost two-fold higher but is lower than in reports published previously (25%). However, there is a wide variability in mortality and morbidity for emergency cholecystectomy in both unadjusted and risk-adjusted analyses. Further studies are required to determine modifiable risk factors to improve outcomes in emergency cholecystectomy.
authors.affiliation: 1 Division of Acute Care Surgery, University of Michigan Department of Surgery , Ann Arbor, Michigan.
authors.forename: Kathleen B
authors.initials: KB
authors.lastname: To
authors.forename: Jill R
authors.initials: JR
authors.lastname: Cherry-Bukowiec
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Englesbe
authors.forename: Michael N
authors.initials: MN
authors.lastname: Terjimanian
authors.forename: Cai
authors.initials: C
authors.lastname: Shijie
authors.forename: Darrell A
authors.initials: DA
authors.lastname: Campbell
authors.forename: Lena M
authors.initials: LM
authors.lastname: Napolitano
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy / Q000379:methods*; D002764:Cholecystitis / Q000601:surgery*; D002769:Cholelithiasis / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000379:methods*; D004635:Emergency Medicine / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008824:Michigan; D008875:Middle Aged; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult