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

被引:86
作者
Kaafarani, Haytham M. A. [1 ]
Smith, Tracy Schifftner [2 ]
Neumayer, Leigh [3 ]
Berger, David H. [4 ]
DePalma, Ralph G. [5 ]
Itani, Kamal M. F. [1 ]
机构
[1] VA Boston Healthcare Syst, Dept Surg, W Roxbury, MA USA
[2] Eastern Colorado Healthcare Syst, Dept Vet Affairs, Denver, CO USA
[3] VA Salt Lake City Hlth Care Syst, Dept Surg, Salt Lake City, UT USA
[4] Michael E DeBakey VA Med Ctr, Dept Surg, Houston, TX USA
[5] Dept Vet Affairs Cent Off, Patient Care Serv, Washington, DC USA
关键词
Laparoscopic cholecystectomy; Open cholecystectomy; Conversion rate; Surgical outcomes; Mortality; Morbidity; Predictors; Secular trends; Quality of care; 30-DAY POSTOPERATIVE MORTALITY; UNIVERSITY MEDICAL-CENTERS; AFFAIRS SURGICAL RISK; LAPAROSCOPIC CHOLECYSTECTOMY; ACUTE CHOLECYSTITIS; QUALITY; CARE; MORBIDITY; IMPROVEMENT; EXPERIENCE;
D O I
10.1016/j.amjsurg.2009.08.020
中图分类号
R61 [外科手术学];
学科分类号
摘要
BACKGROUND: Laparoscopic cholecystectomy (LC) accounts for more than 85% of cholecystectomies. Factors prompting open cholecystectomy (OC) or conversion from LC to OC (CONY) 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. Published by Elsevier Inc.
引用
收藏
页码:32 / 40
页数:9
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