Emergent versus Elective Cholecystectomy: Conversion Rates and Outcomes

BACKGROUND: Laparoscopic cholecystectomy (LC) is the procedure of choice for treatment of cholelithiasis/cholecystitis. Conversion rates (CR) to open cholecystectomy (OC) have been reported previously as 5-15% in elective cases, and up to 25% in patients with acute cholecystitis. We examined the CR in a tertiary-care academic hospital and a statewide surgery quality collaborative, and to compare complications and outcomes in elective and emergency cholecystectomy. METHODS: Prospective data were obtained from: 1) Non-Trauma Emergency Surgery (NTE) database of all emergent cholecystectomies 1/1/2008-12/31/2009; and 2) Michigan Surgical Quality Collaborative (MSQC) database with a random sample of 20-30% of all operations performed 1/1/2005-12/31/2010, including both University of Michigan (UM) data and statewide data from 34 participating hospitals. Patient characteristics, CR, and outcomes were compared for emergent vs. elective cases. RESULTS: Non-trauma ES patients had a mean hospital length of stay (HLOS) of 4.9 d. Open cholecystectomy-HLOS was greater (4.0, LC; 7.9 laparoscopic converted to open cholecystectomy; 8.7, OC, p<0.0001); mortality was 0.35% and CR was 17.5%. In the UM-MSQC dataset, OC-HLOS was greater (6.8 OC vs. 4.6 LC, p<0.001); mortality was 0.65%; CR was 9.1% in elective cases and 14.9% in emergent cases. CR was almost two-fold higher [17.5% of all NTE cholecystectomies vs. 9.1% of UM-MSQC elective cholecystectomies (p=0.00078)]. The statewide MSQC cholecystectomy data showed significantly increased HLOS in emergent cholecystectomy patients (4.34 vs. 2.65 d; p<0.0001). Morbidity (8.8 vs. 3.7%) and mortality (2.6 vs. 0.5%) rates were also significantly higher in emergent vs. elective cholecystectomies (p<0.0001). CONCLUSION: In NTE patients requiring cholecystectomy, CR is almost two-fold higher but is lower than in reports published previously (25%). However, there is a wide variability in mortality and morbidity for emergency cholecystectomy in both unadjusted and risk-adjusted analyses. Further studies are required to determine modifiable risk factors to improve outcomes in emergency cholecystectomy.