Outcome of laparoscopic cholecystectomy conversion: is the surgeon's selection needed?
| Autor: | Lea M. Dijksman, Sandra C. Donkervoort, Joris Derksen, Lincey C. F. de Nes, Pieter G. Versluis, Michael F. Gerhards |
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| Rok vydání: | 2011 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Cholecystitis Acute Preoperative care Body Mass Index Sex Factors Risk Factors Preoperative Care medicine Humans Cholecystectomy Emergency Treatment Aged Retrospective Studies Cholangiopancreatography Endoscopic Retrograde business.industry General surgery Age Factors Retrospective cohort study Odds ratio Triage Confidence interval Surgery Treatment Outcome Cholecystectomy Laparoscopic Female business Body mass index Abdominal surgery Specialization |
| Zdroj: | Surgical endoscopy. 26(8) |
| ISSN: | 1432-2218 |
| Popis: | 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.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.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; p0.001), 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; p0.001). The conversion rate for patients with a history of no complications who had two or more risk factors (gender, age, BMI25) 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.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. |
| Databáze: | OpenAIRE |
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