LAPAROSCOPIC CHOLECYSTECTOMY IN THE GERIATRIC POPULATION

OBJECTIVE: To assess effectiveness and conversion rates of inpatient l aparoscopic cholecystectomy in older people living in the community. S ETTING AND SUBJECTS: All acute care hospitals providing cholecystectom y in a single state. Medicare patients who underwent inpatient cholecy stectomy in fiscal year 1994 in Arkansas. METHODS: A random sample com prising 449 of 2182 geriatric patients who underwent inpatient cholecy stectomy in fiscal year 1994, stratified by hospital bed size, had cha rts reviewed for type of cholecystectomy performed, occurrence of conv ersion from a laparoscopic to an open cholecystectomy, surgical compli cations, and need for transfusion. RESULTS: Eighty-two percent of noni ncidental cholecystectomies were initially laparoscopic. Total convers ion rate for all inpatient laparoscopic cases was 20%. Forty-two perce nt of this group suffered acute cholecystitis,with male patients exhib iting a higher rate of acute cholecystitis than female patients. Conve rsion rates for elective cholecystectomy for both sexes was between 13 and 14%. Conversion rate to an open procedures was 28% for patients w ith acute disease, with male patients again having a higher rate than female patients (40% vs 19%, P < .001). Surgical complications and int raoperative transfusions were rare. Conversion rates did not vary betw een large and small hospitals or among different age groups within the older population. CONCLUSIONS: Inpatient laparoscopic cholecystectomy is common in older people both for acute and chronic gallbladder cond itions. Conversion rates ranged from 13% for elective cholecystectomy to 28% for acute disease. These rates are higher than published litera ture, which focuses on younger populations undergoing elective procedu res. Audit committees need to be aware of this higher conversion rate in older people when assessing surgical proficiency.