New England Surgical Society (NESS)
Search NESS
  Home
  Annual Meeting
  Annual Resident and Fellow Research Day
  Members
      Member Directory
      Members Only
  Scholars Foundation
  Job Board
  Awards
  Journal of the American College of Surgeons
  Newsletters
  Committees
  Contact NESS

Back to NESS Scientific Program


Current Status of Laparoscopic vs. Open Cholecystectomy for Acute Cholecystitis in the United States
Nicholas Csikesz1, Rocco Ricciardi2, Jennifer F Tseng1, Shimul A Shah1
1University of Massachusetts Medical School, Worcester, MA;2Lahey Clinic, Burlington, MA

Objective: To determine national population based outcomes of laparoscopic (LC) and open cholecystectomy (OC) for acute cholecystitis.
Design: We used the National Hospital Discharge Survey (NHDS) obtained from the Centers of Disease Control from 2000-2005 using the International Classification of Diseases, Ninth Revision, Clinical Modification, Sixth Edition.
Setting: Annual medical and demographic data from a national sample of discharge records of non-Federal, short-stay hospitals.
Patients: We identified all patients who underwent LC or OC for acute cholecystitis from 2000-2005 as well as those patients converted from LC to OC.
Main Outcome Measure: Rate of LC or OC, perioperative morbidity and mortality.
Results: Approximately 1 million patients underwent cholecystectomy (859,747 LC; 152,202 OC) for acute cholecystitis from 2000-2005. 37% of patients who underwent LC were discharged within 48 hours after surgery. Of all cases started laparoscopically, 9.5% were converted to OC. Compared to OC, patients who underwent LC were more likely to be discharged to home (91% vs. 70%), carry private insurance (47% vs 30%), suffer less morbidity (25% vs. 37%) and have a lower unadjusted mortality (0.4% vs. 3.4%). In addition, the morbidity (25%) and mortality (0.2%) following open conversion was comparable to those treated entirely with OC. In the logistic regression, OC was associated with a 1.3-fold increase (95% CI 1.35-1.39) in perioperative morbidity compared to LC after adjusting for patient and hospital factors.
Conclusions: In the 21st century, the majority of patients with acute cholecystitis undergo LC with a low conversion rate and acceptable morbidity. Although our patient populations may not be directly comparable, these results may support a continued aggressive approach with laparoscopy for the management of acute cholecystitis.


Back to NESS Scientific Program

Copyright © 2018 New England Surgical Society. All Rights Reserved.
Read Privacy Policy.