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Current Status of Surgical Management of Acute Cholecystitis in the United States

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Abstract

Background

We attempted to determine population-based outcomes of laparoscopic (LC) and open cholecystectomy (OC) for acute cholecystitis (AC).

Methods

We used the National Hospital Discharge Surveys from 2000 through 2005. Annual medical and demographic data from a national sample of discharge records from nonfederal, short-stay hospitals were queried. We identified all patients who underwent LC or OC for AC. The main outcome measures were the rate of LC or OC and in-hospital morbidity and mortality. One million patients underwent cholecystectomy (859,747 LCs; 152,202 OCs) for AC during 2000–2005.

Results

Of the cases started laparoscopically, 9.5% were converted to OC. Compared to OC, patients who underwent LC were more likely to be discharged home (91% vs. 70%), carry private insurance (47% vs. 30%), suffer less morbidity (16% vs. 36%), and have a lower unadjusted mortality (0.4% vs. 3.0%). OC was associated with a 1.3-fold increase (95% confidence interval 1.1–1.4) in perioperative morbidity compared to LC after adjusting for patient and hospital factors.

Conclusions

Most patients in the 21st century with AC undergo LC with a low conversion rate and low morbidity. In the general population with acute cholecystitis, LC results in lower morbidity and mortality rates than OC even in the setting of open conversion.

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Acknowledgments

This work was funded in part by the American Society of Transplant Surgeons Faculty Development Award and the Worcester Foundation for Biomedical Research (SAS).

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Authors and Affiliations

  1. Department of Surgery, Surgical Outcomes Analysis & Research, University of Massachusetts Medical School, 55 Lake Avenue North, S3-838, Worcester, MA, 01655, USA

    Nicholas Csikesz, Jennifer F. Tseng & Shimul A. Shah

  2. Department of Surgery, Lahey Clinic, Burlington, MA, USA

    Rocco Ricciardi

Authors
  1. Nicholas Csikesz
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  2. Rocco Ricciardi
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  3. Jennifer F. Tseng
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  4. Shimul A. Shah
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Corresponding author

Correspondence to Shimul A. Shah.

Additional information

This work was presented at the 88th Annual Meeting of the New England Surgical Society, Burlington VT, September 2007.

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Csikesz, N., Ricciardi, R., Tseng, J.F. et al. Current Status of Surgical Management of Acute Cholecystitis in the United States. World J Surg 32, 2230–2236 (2008). https://doi.org/10.1007/s00268-008-9679-5

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  • DOI: https://doi.org/10.1007/s00268-008-9679-5

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