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Three decades later: investigating the rate of and risks for conversion from laparoscopic to open cholecystectomy

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Abstract

Introduction

Recent data suggest a wide range of conversion (4.9–20%) from laparoscopic (LC) to open cholecystectomy (OC) despite increasing surgeon familiarity and superior equipment. Previously identified risk factors for conversion include increased age, male gender, diabetes, and emergent surgeries. Recent studies also suggest that formal minimally invasive surgical training (MIST) reduces conversion rates. We sought to determine conversion rates in our population, a rural academic medical center, and identify any significant risks for conversion.

Methods

We conducted a single-center retrospective review of 2810 cholecystectomies performed over a seven-year period (2009–2016).

Results

Our study included 837 (29.8%) males and 1973 (70.2%) females with a mean age of 49.2 years. Forty-two percent of cases were done by surgeons with MIST. A total of 139 (4.95%) cases were converted to OC. Univariate predictors of conversion to OC included male gender, age ≥65, urgent and emergent admissions, and MIST of the surgeon. In multivariate modeling, which included significant univariate predictors of conversion, independent predictors of conversion to OC included urgent or emergent admission, male gender, and age ≥65. MIST status was no longer a significant predictor.

Conclusion

Our conversion rate from LC to OC falls within the lower range of recently published rates. This is likely multifactorial, and reflects increasing familiarity of the laparoscopic technique, improved quality of laparoscopic equipment, and/or prior knowledge of preoperative risk factors for conversion. Our results, consistent with previous literature, show a reduced conversion rate among surgeons with MIST. This finding, albeit not significant on multivariate analysis, may offer insight into a potential alterable preoperative risk factor for conversion and warrants further research. Further knowledge about the impact MIST has on conversion may provide a feasible preoperative approach to reducing conversion to OC, thereby reducing costs and overall patient morbidity.

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Acknowledgements

Aggregate patient data were provided by the Jeffords Institute for Quality at the University of Vermont Medical Center. We greatly appreciate the assistance from Jeffords Institute, particularly Dr. Allison Holm (Senior Research Specialist) and Mia Nowlan (Measurement Analyst). The authors would also like to thank Charles Maclean MD for his insight and suggested revisions throughout the drafting of this manuscript.

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Authors and Affiliations

  1. The Robert Larner M.D. College of Medicine, The University of Vermont, 144 N Union St. Apt. 1, Burlington, VT, 05401, USA

    Steven J. Coffin & Wasef Abu-Jaish

  2. Department of Surgery, University of Vermont Medical Center, 111 Colchester Ave, Mailstop 320FL4, Burlington, VT, 05401, USA

    Sean M. Wrenn, Peter W. Callas & Wasef Abu-Jaish

Authors
  1. Steven J. Coffin
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  2. Sean M. Wrenn
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  3. Peter W. Callas
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  4. Wasef Abu-Jaish
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Contributions

Author contributions

SC is the primary author of manuscript text and major contributor to study design, and preformed data collection, review of literature, and statistical analysis. PC provided critical statistical analysis and support and assisted with manuscript revisions. SW assisted with the procurement of data and study design, as well as provided critical revisions to the manuscript. WA-J (senior author) is the principal investigator for the study, designed the idea for the study, and assisted with manuscript drafting and revision.

Corresponding authors

Correspondence to Steven J. Coffin or Wasef Abu-Jaish.

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Disclosures

Mr. Steven J. Coffin, and Drs. Sean M. Wrenn, Peter W. Callas, and Wasef Abu-Jaish have no conflicts of interest or financial ties to disclose.

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Coffin, S.J., Wrenn, S.M., Callas, P.W. et al. Three decades later: investigating the rate of and risks for conversion from laparoscopic to open cholecystectomy. Surg Endosc 32, 923–929 (2018). https://doi.org/10.1007/s00464-017-5767-7

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  • DOI: https://doi.org/10.1007/s00464-017-5767-7

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