Trends, outcomes, and predictors of open and conversion to open cholecystectomy in Veterans Health Administration hospitals

Haytham M A Kaafarani, Tracy Schifftner Smith, Leigh A Neumayer, David H. Berger, Ralph G. Depalma, Kamal M F Itani

Research output: Contribution to journalArticle

64 Citations (Scopus)

Abstract

Background: Laparoscopic cholecystectomy (LC) accounts for more than 85% of cholecystectomies. Factors prompting open cholecystectomy (OC) or conversion from LC to OC (CONV) are not completely understood. Methods: Prospectively collected data from the National Surgical Quality Improvement Program (NSQIP) were combined with administrative data to identify patients undergoing cholecystectomy from October 2005 to October 2008. Three cohorts were defined: LC, OC, and CONV. Using logistic hierarchical modeling, we identified predictors of the choice of OC and the decision to CONV. Results: A total of 11,669 patients underwent cholecystectomy at 117 VA hospitals, including 9,530 LC (81.7%). While the rate of conversion from LC to OC remained stable over the study period (9.0% overall), the percentage of OC decreased from 11.5% in 2006 to 10.1% in 2007 and 8.9% in 2008 (P = .0002). Compared with LC, the OC cohort had more comorbidities (35 of 41 preoperative characteristics, all P <.05), a higher 30-day morbidity rate (18.7% vs 4.8%. P <.0001), and a higher 30-day mortality rate (2.4% vs .4%, P <.0001). American Society of Anesthesiologist (ASA) class, patient comorbidities (eg, ascites, bleeding disorders, pneumonia) and functional status predicted a choice of OC. Age, preoperative albumin, previous abdominal surgery and emergency status predicted OC and CONV (all P <.05). A higher hospital conversion rate was independently predictive of OC (odds ratio [1% rate increase]: 1.05 [1.02-1.07]; P = .0004). Conclusion: In the last 3 years, there has been a trend towards performing fewer OCs in VA hospitals. More patient comorbidities and higher hospital-level conversion rates are predictive of the choice to perform or convert to OC.

Original languageEnglish (US)
Pages (from-to)32-40
Number of pages9
JournalAmerican Journal of Surgery
Volume200
Issue number1
DOIs
StatePublished - Jul 2010
Externally publishedYes

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Veterans Health
United States Department of Veterans Affairs
Cholecystectomy
Laparoscopic Cholecystectomy
Comorbidity
Quality Improvement
Ascites

Keywords

  • Conversion rate
  • Laparoscopic cholecystectomy
  • Morbidity
  • Mortality
  • Open cholecystectomy
  • Predictors
  • Quality of care
  • Secular trends
  • Surgical outcomes

ASJC Scopus subject areas

  • Surgery

Cite this

Trends, outcomes, and predictors of open and conversion to open cholecystectomy in Veterans Health Administration hospitals. / Kaafarani, Haytham M A; Smith, Tracy Schifftner; Neumayer, Leigh A; Berger, David H.; Depalma, Ralph G.; Itani, Kamal M F.

In: American Journal of Surgery, Vol. 200, No. 1, 07.2010, p. 32-40.

Research output: Contribution to journalArticle

Kaafarani, Haytham M A ; Smith, Tracy Schifftner ; Neumayer, Leigh A ; Berger, David H. ; Depalma, Ralph G. ; Itani, Kamal M F. / Trends, outcomes, and predictors of open and conversion to open cholecystectomy in Veterans Health Administration hospitals. In: American Journal of Surgery. 2010 ; Vol. 200, No. 1. pp. 32-40.
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abstract = "Background: Laparoscopic cholecystectomy (LC) accounts for more than 85{\%} of cholecystectomies. Factors prompting open cholecystectomy (OC) or conversion from LC to OC (CONV) are not completely understood. Methods: Prospectively collected data from the National Surgical Quality Improvement Program (NSQIP) were combined with administrative data to identify patients undergoing cholecystectomy from October 2005 to October 2008. Three cohorts were defined: LC, OC, and CONV. Using logistic hierarchical modeling, we identified predictors of the choice of OC and the decision to CONV. Results: A total of 11,669 patients underwent cholecystectomy at 117 VA hospitals, including 9,530 LC (81.7{\%}). While the rate of conversion from LC to OC remained stable over the study period (9.0{\%} overall), the percentage of OC decreased from 11.5{\%} in 2006 to 10.1{\%} in 2007 and 8.9{\%} in 2008 (P = .0002). Compared with LC, the OC cohort had more comorbidities (35 of 41 preoperative characteristics, all P <.05), a higher 30-day morbidity rate (18.7{\%} vs 4.8{\%}. P <.0001), and a higher 30-day mortality rate (2.4{\%} vs .4{\%}, P <.0001). American Society of Anesthesiologist (ASA) class, patient comorbidities (eg, ascites, bleeding disorders, pneumonia) and functional status predicted a choice of OC. Age, preoperative albumin, previous abdominal surgery and emergency status predicted OC and CONV (all P <.05). A higher hospital conversion rate was independently predictive of OC (odds ratio [1{\%} rate increase]: 1.05 [1.02-1.07]; P = .0004). Conclusion: In the last 3 years, there has been a trend towards performing fewer OCs in VA hospitals. More patient comorbidities and higher hospital-level conversion rates are predictive of the choice to perform or convert to OC.",
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AU - Smith, Tracy Schifftner

AU - Neumayer, Leigh A

AU - Berger, David H.

AU - Depalma, Ralph G.

AU - Itani, Kamal M F

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N2 - Background: Laparoscopic cholecystectomy (LC) accounts for more than 85% of cholecystectomies. Factors prompting open cholecystectomy (OC) or conversion from LC to OC (CONV) are not completely understood. Methods: Prospectively collected data from the National Surgical Quality Improvement Program (NSQIP) were combined with administrative data to identify patients undergoing cholecystectomy from October 2005 to October 2008. Three cohorts were defined: LC, OC, and CONV. Using logistic hierarchical modeling, we identified predictors of the choice of OC and the decision to CONV. Results: A total of 11,669 patients underwent cholecystectomy at 117 VA hospitals, including 9,530 LC (81.7%). While the rate of conversion from LC to OC remained stable over the study period (9.0% overall), the percentage of OC decreased from 11.5% in 2006 to 10.1% in 2007 and 8.9% in 2008 (P = .0002). Compared with LC, the OC cohort had more comorbidities (35 of 41 preoperative characteristics, all P <.05), a higher 30-day morbidity rate (18.7% vs 4.8%. P <.0001), and a higher 30-day mortality rate (2.4% vs .4%, P <.0001). American Society of Anesthesiologist (ASA) class, patient comorbidities (eg, ascites, bleeding disorders, pneumonia) and functional status predicted a choice of OC. Age, preoperative albumin, previous abdominal surgery and emergency status predicted OC and CONV (all P <.05). A higher hospital conversion rate was independently predictive of OC (odds ratio [1% rate increase]: 1.05 [1.02-1.07]; P = .0004). Conclusion: In the last 3 years, there has been a trend towards performing fewer OCs in VA hospitals. More patient comorbidities and higher hospital-level conversion rates are predictive of the choice to perform or convert to OC.

AB - Background: Laparoscopic cholecystectomy (LC) accounts for more than 85% of cholecystectomies. Factors prompting open cholecystectomy (OC) or conversion from LC to OC (CONV) are not completely understood. Methods: Prospectively collected data from the National Surgical Quality Improvement Program (NSQIP) were combined with administrative data to identify patients undergoing cholecystectomy from October 2005 to October 2008. Three cohorts were defined: LC, OC, and CONV. Using logistic hierarchical modeling, we identified predictors of the choice of OC and the decision to CONV. Results: A total of 11,669 patients underwent cholecystectomy at 117 VA hospitals, including 9,530 LC (81.7%). While the rate of conversion from LC to OC remained stable over the study period (9.0% overall), the percentage of OC decreased from 11.5% in 2006 to 10.1% in 2007 and 8.9% in 2008 (P = .0002). Compared with LC, the OC cohort had more comorbidities (35 of 41 preoperative characteristics, all P <.05), a higher 30-day morbidity rate (18.7% vs 4.8%. P <.0001), and a higher 30-day mortality rate (2.4% vs .4%, P <.0001). American Society of Anesthesiologist (ASA) class, patient comorbidities (eg, ascites, bleeding disorders, pneumonia) and functional status predicted a choice of OC. Age, preoperative albumin, previous abdominal surgery and emergency status predicted OC and CONV (all P <.05). A higher hospital conversion rate was independently predictive of OC (odds ratio [1% rate increase]: 1.05 [1.02-1.07]; P = .0004). Conclusion: In the last 3 years, there has been a trend towards performing fewer OCs in VA hospitals. More patient comorbidities and higher hospital-level conversion rates are predictive of the choice to perform or convert to OC.

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KW - Predictors

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KW - Surgical outcomes

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