PMID- 22398961
OWN - NLM
STAT- MEDLINE
DCOM- 20121010
LR  - 20211021
IS  - 1432-2218 (Electronic)
IS  - 0930-2794 (Linking)
VI  - 26
IP  - 8
DP  - 2012 Aug
TI  - Outcome of laparoscopic cholecystectomy conversion: is the surgeon's selection 
      needed?
PG  - 2360-6
LID - 10.1007/s00464-012-2189-4 [doi]
AB  - BACKGROUND: Risk factors for conversion in cholecystectomy may be of clinical 
      value. This study aimed to investigate whether a set of risk factors, including 
      the surgeon's specialization, can be used for the development of a preoperative 
      strategy to optimize conversion outcome. METHODS: The data for all patients who 
      underwent laparoscopic cholecystectomy at a single institution between January 
      2004 and December 2008 were retrospectively reviewed. Factors predictive for 
      conversion were identified, and a preoperative strategy model was deduced. 
      RESULTS: Of the 1,126 patients analyzed, 106 (9%) underwent laparoscopic 
      cholecystectomy in an emergency setting. Delayed surgery was performed for 63 
      (46%) of 138 patients (12%) with acute cholecystitis. Preoperative endoscopic 
      retrograde cholangiography was achieved for 161 of the patients (14%). Risk 
      factors predictive of conversion (for 65 patients) were male gender [odds ratio 
      (OR), 2.3; 95% confidence interval (CI), 1.3-3.9; p = 0.004], age older than 65 
      years (OR, 2.6; 95% CI, 1.4-4.8; p = 0.002), body mass index (BMI) exceeding 25 
      kg/m(2) (OR, 3.4; 95% CI, 1.7-7.1; p < 0.001), history of complicated biliary 
      disease (HCBD) (OR, 5.6; 95% CI, 3.2-9.8; p = < 0.001), and surgery by a 
      non-gastrointestinal (non-GI) surgeon (OR, 4.9; 95% CI, 2.2-10.6; p < 0.001). The 
      conversion rate for patients with a history of no complications who had two or 
      more risk factors (gender, age, BMI > 25) and for patients with a HCBD who had 
      one or more risk factors was significantly higher if the surgery was performed by 
      non-GI rather than GI surgeons. CONCLUSION: Male gender, age older than 65 years, 
      BMI exceeding 25 kg/m(2), HCBD, and surgery by a non-GI surgeon are predictive 
      for conversion. A preoperative triage for surgeon selection based on risk factors 
      and a HCBD is proposed to optimize conversion outcome.
FAU - Donkervoort, Sandra C
AU  - Donkervoort SC
AD  - Department of Surgery, Onze Lieve Vrouwe Gasthuis (OLVG), 95500, 1090 Amsterdam, 
      HM, The Netherlands. donkpas@wanadoo.nl
FAU - Dijksman, Lea M
AU  - Dijksman LM
FAU - de Nes, Lincey C F
AU  - de Nes LC
FAU - Versluis, Pieter G
AU  - Versluis PG
FAU - Derksen, Joris
AU  - Derksen J
FAU - Gerhards, Michael F
AU  - Gerhards MF
LA  - eng
PT  - Journal Article
DEP - 20120308
PL  - Germany
TA  - Surg Endosc
JT  - Surgical endoscopy
JID - 8806653
SB  - IM
MH  - Age Factors
MH  - Aged
MH  - Body Mass Index
MH  - Cholangiopancreatography, Endoscopic Retrograde
MH  - Cholecystectomy/*methods/statistics & numerical data
MH  - Cholecystectomy, Laparoscopic/methods/statistics & numerical data
MH  - Cholecystitis, Acute/*surgery
MH  - Emergency Treatment
MH  - Female
MH  - Humans
MH  - Male
MH  - Preoperative Care/*methods
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Sex Factors
MH  - Specialization/*statistics & numerical data
MH  - Treatment Outcome
MH  - Triage
EDAT- 2012/03/09 06:00
MHDA- 2012/10/12 06:00
CRDT- 2012/03/09 06:00
PHST- 2011/08/27 00:00 [received]
PHST- 2012/01/23 00:00 [accepted]
PHST- 2012/03/09 06:00 [entrez]
PHST- 2012/03/09 06:00 [pubmed]
PHST- 2012/10/12 06:00 [medline]
AID - 10.1007/s00464-012-2189-4 [doi]
PST - ppublish
SO  - Surg Endosc. 2012 Aug;26(8):2360-6. doi: 10.1007/s00464-012-2189-4. Epub 2012 Mar 
      8.