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Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons
56th Annual Meeting Abstracts


Poster 3

Abstract Title

Conversions in Laparoscopic Cholecystectomy: Is the Quicker Surgery Worth the Price?

 

Author Block

Balazs Lengyel, MD, Maria Theresa Panizales, MD, Jill Steinberg, MD, Stanley Ashley, MD, Ali Tavakkolizadeh, MD
Department of Surgery, Brigham and Women's Hospital, Boston, MA

 

Abstract Body

Background: Laparoscopic Cholecystectomy (LC) is the gold standard procedure for gallbladder removal although conversion to open surgery is sometimes necessary. The factors underlying this decision are unclear; however, an association between long laparoscopic procedures and increased complications and cost is frequently hypothesized, promoting clinicians to consider early conversion. This study aims to compare outcomes of converted and prolonged LC cases to test this hypothesis.

Methods: Using the NSQIP database and financial records, we retrospectively reviewed 1,193 cholecystectomies performed at our institution between 2002 and 2009, and compared the longest 10% of all laparoscopic cases (Long-LC) to converted (CONV) procedures. Length of stay (LOS), 30-day complications, operative times and charges, as well as hospital charges were compared between groups. Poisson regression and Wilcoxon test were used to compare outcomes. Results: 110 Long-LC and 62 CONV cases were included in the analysis (Table 1). LOS was significantly shorter in the Long-LC compared to CONV group (1.4 vs. 4.6, p<0.01). Although Long-LC cases had higher operative charges, the overall hospital charges for Long-LC cases were substantially lower (,200 vs. ,768, p<0.01).

Conclusion: Conversion is associated with shorter operative times, but leads to a 3-day increase in LOS and significantly higher overall hospital charges. Results favor pursuing a laparoscopic approach instead of early conversion to open surgery, although safety considerations must be taken into account when making such decisions.

 

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