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Laparoscopic Cholecystectomy: What is the Price of Conversion?

2011; Elsevier BV; Volume: 165; Issue: 2 Linguagem: Inglês

10.1016/j.jss.2010.11.604

1095-8673

Balazs I. Lengyel, Stanley W. Ashley, Maria Theresa P. Panizales, Jill Steinberg, Ali Tavakkolizadeh,

Pancreatic and Hepatic Oncology Research

Introduction: Laparoscopic Cholecystectomy (LC) is the gold standard procedure for gallbladder removal. Despite advancement of minimally invasive techniques and equipment, conversion to open surgery is deemed necessary in some cases, although factors underlying this decision are often poorly understood. It is frequently hypothesized that difficult and long laparoscopic procedures are associated not only with increased operative times, but also increased complications and cost when compared to converted cases. The purpose of this study is to compare outcomes, focusing on cost, of converted and prolonged LC cases to determine if data supports the above hypothesis. Methods: Using the institutional NSQIP database and financial records, we retrospectively reviewed 1,122 cholecystectomies performed in our institution between 2002 and 2009, and compared the longest 10% of all laparoscopic cases (Long-LC) to converted (CONV) procedures. Admissions that included additional procedures or treatments unrelated to gallbladder disease were excluded. Length of stay (LOS), 30-day complications, operative room charges, anesthesia charges, recovery room charges and total hospital charges were compared between the 2 groups. Poisson regression and Wilcoxon ranked sum test (for non-parametric variables) were used to compare outcomes and charges. Results: The median operative time was 63 minutes for the 1,122 LC identified. 110 long-LC and 62 CONV cases met our inclusion criteria. There were no differences in the rate of post-operative complications between the 2 groups (P>0.05). Long-LC cases took 35 minutes longer to perform than CONV cases (123 min vs. 88 min, respectively, p<0.01). Using Poisson regression, LOS was significantly shorter in the Long-LC compared to CONV group (1.4 vs. 4.6, respectively p<0.01). Hospital charges are summarized in Table 1. Long-LC cases had higher operative charges ($17,362 vs. $14,528, respectively; p 0.01). Conclusions: Conversion is associated with a three day increase in LOS. Long-LC cases have higher operative room charges but overall hospital charges are $7,500 less than CONV cases. Our cost and LOS data in difficult LC cases favor pursuing a laparoscopic approach instead of conversion to open surgery, although safety considerations need to be taken into account when making decisions. Table 1Outcomes and charge data Long-LC CONV p value Number of cases 110 62 Medium OR time (min) 123 88 <0.001 Length of Stay (days) 1.41 4.63 <0.001 Operative room charges ($) 12,626 10,372 <0.005 Anesthesia charges ($) 1,460 1,143 <0.001 Recovery room charges ($) 1,596 1,787 NS Total operative room charges ($)* 17,362 14,528 <0.001 Total hospital charges ($) 24,200 31,768 <0.001 Open table in a new tab