Elsevier

Surgery

Volume 144, Issue 2, August 2008, Pages 283-289
Surgery

Outcome
Trends in surgical management for acute cholecystitis

https://doi.org/10.1016/j.surg.2008.03.033Get rights and content

Introduction

Cholecystectomy, which can be performed with either a laparoscopic (LC) or open (OC) approach, remains the definitive treatment for acute cholecystitis (AC) in the United States. There has not been an overall evaluation of the safety and efficacy of LC vs. OC as treatment for AC.

Methods

We used the Nationwide Inpatient Sample to identify all patients with AC from 1998-2005. Rates of LC or OC, patient and hospital characteristics, hospital cost, and mortality were analyzed. In order to assess if differences in outcomes exist, propensity scores were created to eliminate differences in cohorts. A case-controlled analysis was then performed, comparing in-hospital mortality and likelihood of conversion to OC.

Results

From approximately 1.8 million admissions for AC, 1.4 million patients underwent cholecystectomy (1,240,212 LC; 147,190 OC) for AC from 1998 to 2005. The number of cholecystectomies increased over time. The ratio of LC performed increased from 83% in 1998 to 93% in 2005; 12% of cases were attempted laparoscopically but converted to OC. When compared with OC, patients who underwent LC were more likely to be female, carry private insurance, be discharged to home, have lesser hospital cost per patient, have no comorbid conditions, and have a lesser unadjusted mortality. After adjusting for age, comorbidity and sex, the adjusted odds ratio for death was 4.6-fold greater (95% CI 4.1–5.1) with OC compared with LC as the treatment for AC.

Conclusions

LC is performed with increasing frequency as the treatment for AC with lesser mortality, hospital stay, and cost compared with OC. Despite differences in cohorts, these results support a continued aggressive approach with laparoscopy as the treatment of choice for AC.

Section snippets

Materials and methods

We used the NIS for the years 1998 to 2005 to extract data for all patients with AC. The NIS is the largest national, all-payer, hospital inpatient care database in the United States. It is supported by the Healthcare Cost and Utilization Project and contains all-payer discharge information for 100% of patient discharges from participating hospitals. Data exist for approximately seven million hospital discharges per year from a stratified sample of 20% of nonfederal U.S. community hospitals

Demographics

From approximately 1.8 million admissions for AC, 1.4 million patients (76%) underwent cholecystectomy (1,240,212 LC; 147,190 OC) for AC from 1998 to 2005. The number of patients admitted with AC and subsequently the number of cholecystectomies performed for AC increased over time. When examined by year, the rate of cholecystectomy (LC or OC) remained constant throughout the course of the study (76%). The ratio of LC performed increased from 83% in 1998 to 93% in 2005 (Fig 1).

Demographic

Discussion

Acute cholecystitis in the current era is usually treated with cholecystectomy with excellent results and patient outcomes. Since the advent of laparoscopy, the indications and use of LC have expanded. We are now 20 years removed from the first LC and important questions concerning current safety, new indications, and outcomes need to be addressed for AC.

The results of this population-based study confirm that the diagnosis and treatment of AC with operative treatment is increasing. Over the

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    Presented at the 3rd Annual Academic Surgical Congress, Huntington Beach, California, February 2008.

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