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      Preoperative Risk Factors for Conversion of Laparoscopic Cholecystectomy to Open Surgery - A Systematic Review and Meta-Analysis of Observational Studies

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          Abstract

          Background: Preoperative risk factors for the conversion of laparoscopic cholecystectomy to open surgery have been identified, but never been explored systematically. Our objective was to systematically present the evidence of preoperative risk factors for conversion of laparoscopic cholecystectomy to open surgery. Methods: PubMed and Embase were searched systematically in March 2014. Observational studies evaluating preoperative risk factors for conversion of laparoscopic cholecystectomy to open surgery in patients with gallstone disease were included. The outcome variables extracted were patient demographics, medical history, severity of gallstone disease, and preoperative laboratory values. Results: A total of 1,393 studies were screened for eligibility. We found 32 studies, including 460,995 patients operated with laparoscopic cholecystectomy, eligible for the systematic review. Of these, 10 studies were suitable for 7 meta-analyses on age, gender, body mass index, previous abdominal surgery, severity of disease, white blood cell count, and gallbladder wall thickness. Conclusions: A gallbladder wall thicker than 4-5 mm, a contracted gallbladder, age above 60 or 65, male gender, and acute cholecystitis were risk factors for the conversion of laparoscopic cholecystectomy to open surgery. Furthermore, there was no association between diabetes mellitus or white blood cell count and conversion to open surgery.

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          Conversion after laparoscopic cholecystectomy in England.

          M Ballal, D Corless, Batty G David … (2009)
          Laparoscopic cholecystectomy is the procedure of choice for the treatment of symptomatic gallstones. Conversion to open surgery is reported to be necessary in 5-10% of cases. This study aimed to define those factors associated in English hospitals with the need to convert a laparoscopic cholecystectomy to an open procedure. These included patient-related and particularly nonpatient-related factors. Using data derived from a national administrative database, Hospital Episode Statistics, patients undergoing cholecystectomy in acute National Health Service (NHS) hospitals in England during the financial years 2004-2006 were studied. The individual surgeon caseload and the hospital conversion rate were calculated using data from the first (baseline) year. Factors affecting the need for conversion were analyzed using data from the second (index) year. The study included 43,821 laparoscopic cholecystectomies undertaken from 2005 to 2006 in English hospitals. The overall conversion rate was 5.2%: 4.6% for elective procedures and 9.4% for emergency procedures. Patient-related factors that were good predictors of conversion included male sex, emergency admission, old age, and complicated gallstone disease (p < 0.001). Nonpatient-related factors that were good predictors of conversion included the laparoscopic cholecystectomy caseload of individual consultant surgeons and the overall hospital conversion rate in the previous year (all p < 0.001). Conversion after laparoscopic cholecystectomy is less common as consultant caseload increases. This suggests that operation should be undertaken only by surgeons with an adequate caseload. There is a wide variation in conversion rates among hospitals. This has important implications for training as well as for the organization and accreditation of cholecystectomy services on a national basis.
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            Epidemiological study of provision of cholecystectomy in England from 2000 to 2009: retrospective analysis of Hospital Episode Statistics.

            Sidhartha Sinha, Peter Friend, David Hofman … (2012)
            The aim of this study was to report the trends in provision of cholecystectomy in the National Health System in England over the 9 year period from 2000 to 2009 and to determine the major risk factors associated with subsequent poor outcome. The Hospital Episode Statistics database was interrogated to identify all cholecystectomy procedures for biliary stone disease in adult patients (>16 years). Multivariate regression analyses were used to identify independent predictors of in-patient death, 1 year death, conversion to open, major bile duct injury (BDI) requiring operative repair, and length of stay. A total of 418,214 cholecystectomy procedures for biliary stone disease were identified. Laparoscopic surgery was used in 348,311 (83.3%) cases and increased by 14.6% over the study period. The in-patient mortality rate (0.2%), 1 year mortality rate (1%), proportion of cases converted to open (5.0%), major BDI rate (0.4%), and mean length of stay (3 days) all decreased over the study period. 52,242 (12.5%) cases were carried out during an emergency admission and uptake has remained stable over the decade. Emergency surgery was more likely to be performed at high-volume centres (odds ratio [OR] 1.39, 95% confidence interval [CI] 1.35-1.44) and specialist units (OR 1.32, 95% CI 1.30-1.35). High-volume centres were more likely to complete emergency cases laparoscopically (OR 1.11, 95% CI 1.05-1.18). Multivariate regression analysis demonstrated that patient- (male gender, increasing age, and comorbidity) and disease-specific (inflammatory pathology and emergency admission) factors rather than hospital institutional characteristics (annual cholecystectomy volume and presence of specialist surgical units) were associated with poorer outcomes. The provision of laparoscopic cholecystectomy in England has increased. This has been associated with improvements in outcomes such as mortality and length of stay. However, emergency cholecystectomy uptake remains sub-optimal and is more likely to be performed at high-volume or specialist hospitals without adverse outcomes. Further research into the routine provision of emergency cholecystectomy in England is needed in order to optimize patient outcomes.
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              Risk factors resulting in conversion of laparoscopic cholecystectomy to open surgery.

              M Doganay, Steven Reis, M Atli … (2001)
              Laparoscopic cholecystectomy has become the standard treatment for symptomatic gallbladder diseases. However, there still is a substantial proportion of patients in whom laparoscopic cholecystectomy cannot be successfully performed, and for whom conversion to open surgery is required. In this study, 1,000 laparoscopic cholecystectomies performed at Ankara Numune Hospital, Fourth Department of Surgery, from March 1992 to July 1999 were prospectively analyzed. The patients studied included 804 women (80.4%) and 196 men (19.6%) with a mean age of 43.8 years (range, 30-80 years). From the data collected, only factors available to the surgeon preoperatively were considered for analysis. These factors included age, gender, history of acute cholecystitis, jaundice or pancreatitis, previous abdominal surgery, obesity and concomitant disease, white blood cell (WBC) count, preoperative liver function tests, ultrasound findings of the gallbladder, preoperative endoscopic retrograde cholangiopancreatography (ERCP), and suspicion of common bile duct stones. Also we analyzed the case numbers as a measure of institutional experience. Of the 1,000 patients in whom laparoscopic cholecystectomy was attempted, 48 (4.8%) required conversion to open surgery. The most common reason for conversion was inability to define anatomy in patients with inflamed contracted gallbladder (n = 34). Significantly independent predictive factors for conversion were male gender, previous abdominal surgery, acute cholecystitis, thickened gallbladder wall on preoperative ultrasonography, and suspicion of common bile duct stones. An appreciation for the aforementioned predictors of conversion will allow appropriate planning by the patient, the institution, and the surgeon.
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                Author and article information

                Journal
                Journal ID (publisher-id): DSU
                Journal ID (nlm-ta): Dig Surg
                Journal ID (doi): 10.1159/issn.0253-4886
                Title: Digestive Surgery
                Abbreviated Title: Dig Surg
                Publisher: S. Karger AG (Basel, Switzerland karger@ 123456karger.com http://www.karger.com )
                ISSN (Print): 0253-4886
                ISSN (Electronic): 1421-9883
                Publication date (Print): June 2016
                Publication date (Electronic): 05 May 2016
                Volume: 33
                Issue: 5
                Pages: 414-423
                Affiliations
                aDepartment of Surgery, Center for Perioperative Optimization, Herlev Hospital, and bEmergency Medical Service Copenhagen, University of Copenhagen, Copenhagen, Denmark
                Article
                Publisher ID: DSU2016033005414 Other ID: Dig Surg 2016;33:414-423
                DOI: 10.1159/000445505
                PubMed ID: 27160289
                SO-VID: 3be5db9a-b270-4119-ab1e-3227a4d0f01d
                Copyright © © 2016 S. Karger AG, Basel
                License:

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                Date received : 17 January 2015
                Date accepted : 15 March 2016
                Page count
                Figures: 2, Tables: 3, References: 61, Pages: 10
                Categories
                Subject: Review Article

                ScienceOpen disciplines: Medicine,General social science
                Keywords: Cholecystectomy,Risk factors,Conversion,Preoperative,Systematic review
                Data availability:
                ScienceOpen disciplines: Medicine, General social science
                Keywords: Cholecystectomy, Risk factors, Conversion, Preoperative, Systematic review

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