90th Annual Meeting Abstracts
Surgical Management Of Acute Cholecystitis In The Modern Era
*Jason T Wiseman, BA, *Maia N Sharuk, BA, Demetrius EM Litwin, MD, MBA, *Mitchell Cahan, MD, *Jennifer F Tseng, MD, MPH, *Shimul A Shah, MD
University of Massachusetts Medical School, Worcester, MA
Objective: To describe the current trends in surgical management for patients with acute cholecystitis (AC) at a tertiary care center.
Design: Retrospective data collection and analysis
Setting: Hospital admission with primary diagnosis of AC from a tertiary care center from 1/2002-1/2007.
Patients: 923 patients were admitted with a primary diagnosis of AC from 1/2002 - 1/2007. Patients with missing data, incomplete operative notes and documents, and metastatic GI cancer were excluded (n=72).
Interventions: Statistical analyses with chi-square, Student’s t-test, and ANOVA
Main outcome measures: Patient demographical characteristics, preoperative morbidity, procedures (medical and surgical), and post-operative outcomes.
Results: 809 patients (87.6%) underwent surgery by 44 surgeons with a primary diagnosis of AC [laparoscopic cholecystectomy (LC) n=663, 82.0%; open cholecystectomy (OC) n=9, 1.1%; open conversion (CONV) n=51, 6.3%; cholecystostomy tube (CCT) n=86, 10.6%]. LC was performed most frequently (82.0%) compared to the other three interventions. During this time, the number of CCTs increased, while OCs and CONVs decreased. LC was the procedure of choice for healthy patients with AC (preoperative morbidity score 0.8 vs. 2.2 for other modalities). LC had significantly better outcomes including reduced post-surgical stay (2.2 days for LC vs. 6.3 days for other modalities) and reduced complication rate (8.5% for LC vs. 17.0% for other modalities.)
Conclusions: Based on these results from a tertiary care center over 6 years, LC was performed with a low conversion rate, lower morbidity and mortality compared to other procedures across all surgical faculty. Our data confirms the known benefits and widespread use of LC in the current era reflecting a change in the training paradigm and learning curve in laparoscopy.