title: Preoperative prediction model for conversion of laparoscopic to open cholecystectomy in patient with acute cholecystitis: based on clinical, laboratory, and CT parameters.
abstract: OBJECTIVE
  To identify preoperative computed tomography (CT) predictors associated with conversion from laparoscopic to open cholecystectomy and to propose the risk scoring model for prediction of conversion by integrating clinical, laboratory, and CT parameters.
  
  
  METHODS
  The institutional review board approved this retrospective study, and informed consent was waived. One hundred eighty-three patients who underwent a laparoscopic cholecystectomy for acute cholecystitis were evaluated for clinical, laboratory, and CT parameters. Associations between conversion and these parameters were assessed by using univariate and multivariate logistic regression analysis. The risk scoring model was devised using a regression coefficient-based scoring method.
  
  
  RESULTS
  Conversion to open cholecystectomy was performed in 30 patients (17%). Multivariate analysis identified age older than 60 years, male, and pericholecystic fluid as independent predictors of conversion. The preoperative prediction model to calculate the risk score for conversion showed sensitivity of 83% and specificity of 72%, with an area under the receiver operator curve of 0.83.
  
  
  CONCLUSIONS
  Pericholecystic fluid collection was the only CT parameter with clinical parameters of age older than 60 years and male in prediction for conversion in acute cholecystitis. The preoperative prediction model using these 3 parameters can be adapted easily in clinical practice with a good discrimination.
authors.affiliation: From the Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Mi Sung
authors.initials: MS
authors.lastname: Kim
authors.forename: Heon-Ju
authors.initials: HJ
authors.lastname: Kwon
authors.forename: Hae Won
authors.initials: HW
authors.lastname: Park
authors.forename: Ji Yeon
authors.initials: JY
authors.lastname: Park
authors.forename: Eun-Chul
authors.initials: EC
authors.lastname: Chung
authors.forename: Hee-Jin
authors.initials: HJ
authors.lastname: Park
authors.forename: Hyon Joo
authors.initials: HJ
authors.lastname: Kwag
authors.forename: Hyun Pyo
authors.initials: HP
authors.lastname: Hong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic / Q000706:statistics & numerical data*; D041881:Cholecystitis, Acute / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D003131:Combined Modality Therapy / Q000706:statistics & numerical data; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000706:statistics & numerical data; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D012086:Reoperation / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D055815:Young Adult