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Preoperative determinants of a high risk patient for conversion from laproscopic to open cholecystectomy

1 August 2002


Background: Gallbladder disease is a common disease of the biliary tract that affects multiple Americans annually. It is successfully treated surgically and the advent of laparoscopic cholecystectomy has provided patients with multiple benefits including shorter hospital stays and smaller hospital bills. Infrequently this procedure is converted to the open procedure for multiple reasons, leaving the patient unprepared postoperatively.

Objective: To develop a protocol with which to predict a patient's risk of conversion from laparoscopic to open cholecystectomy with preoperative factors such as patient demographics and lab values. Methods: A retrospective chart review was conducted from Nov. 1996 - March 2002 for all patients receiving cholecystectomy. Data was compiled and frequency distributions, means, standard deviations, t-values, p-values and discriminatory analysis were calculated.

Results: Subjects who required conversion had a higher percentage of urgent and emergent surgeries and a higher percentage were male. Significant p values (p < .05) were determined for the length of symptoms prior to surgery, age, total bilirubin, WBC, AST and Alkaline Phosphatase. Discriminate analysis revealed the combination of .Alkaline Phosphatase, WBC and age provided an 82% success rate at predicting group membership.

Discussion: Subjects who required conversion to the open procedure had significantly elevated lab values, were significantly older and had a more severe disease state. Further research needs to be done in order to develop a clinically significant protocol, but these results provide conclusive data with which to predict risk groups.


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