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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.
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