Trends in surgical management for acute cholecystitis

INTRODUCTION: Cholecystectomy, which can be performed with either a laparoscopic (LC) or open (OC) approach, remains the definitive treatment for acute cholecystitis (AC) in the United States. There has not been an overall evaluation of the safety and efficacy of LC vs. OC as treatment for AC. METHODS: We used the Nationwide Inpatient Sample to identify all patients with AC from 1998-2005. Rates of LC or OC, patient and hospital characteristics, hospital cost, and mortality were analyzed. In order to assess if differences in outcomes exist, propensity scores were created to eliminate differences in cohorts. A case-controlled analysis was then performed, comparing in-hospital mortality and likelihood of conversion to OC. RESULTS: From approximately 1.8 million admissions for AC, 1.4 million patients underwent cholecystectomy (1,240,212 LC; 147,190 OC) for AC from 1998 to 2005. The number of cholecystectomies increased over time. The ratio of LC performed increased from 83% in 1998 to 93% in 2005; 12% of cases were attempted laparoscopically but converted to OC. When compared with OC, patients who underwent LC were more likely to be female, carry private insurance, be discharged to home, have lesser hospital cost per patient, have no comorbid conditions, and have a lesser unadjusted mortality. After adjusting for age, comorbidity and sex, the adjusted odds ratio for death was 4.6-fold greater (95% CI 4.1-5.1) with OC compared with LC as the treatment for AC. CONCLUSIONS: LC is performed with increasing frequency as the treatment for AC with lesser mortality, hospital stay, and cost compared with OC. Despite differences in cohorts, these results support a continued aggressive approach with laparoscopy as the treatment of choice for AC