Surgical management of acute cholecystitis at a tertiary care center in the modern era

Abstract

Hypothesis: The advent of laparoscopy has changed the paradigm of surgical training and care delivery for the treatment of patients with acute cholecystitis (AC). Design: Retrospective data collection and analysis. Setting: Hospital admissions with a primary diagnosis of AC at a tertiary care center from January 1, 2002, to January 1, 2007. Patients: During the study period, 923 patients were admitted with a primary diagnosis of AC. One hundred fourteen patients were excluded from the study because of missing data, medical management, incomplete operative notes or documents, or metastatic gastrointestinal cancer. Main Outcome Measures: Patient demographics, preoperative morbidity, procedures (medical and surgical), and postoperative outcomes were statistically analyzed using x2 test, t test, and analysis of variance. Results: Eight hundred nine patients (87.6%) with a primary diagnosis of AC underwent surgery by 44 surgeons. Procedures included 663 laparoscopic cholecystectomies (LCs) (82.0%), 9 open cholecystectomies (1.1%), 51 conversions fromLCto open cholecystectomy (6.3%), and 86 cholecystostomytubeplacements(10.6%).Duringthestudy period, cholecystostomy tube placements increased, while open cholecystectomies and conversions fromLCto open cholecystectomy decreased (P