The impact of patient delay and physician delay on the outcome of laparoscopic cholecystectomy for acute cholecystitis

BACKGROUND: Laparoscopic cholecystectomy is now used in the management of a cute cholecystitis. Under these circumstances unfavorable conditions may re sult in conversion and complications. Information about these conditions ma y help in planning the laparoscopic approach or in proceeding directly to o pen cholecystectomy. This study was initiated to evaluate perioperative fac tors associated with conversion and complications of laparoscopic cholecyst ectomy in acute cholecystitis. Special attention was paid to the duration o f complaints until surgery, to the delay on the part of the patient, and to the delay on the part of the physician. METHODS: Between January 1994 and December 1997, we attempted to perform la paroscopic cholecystectomy on 348 patients with acute cholecystitis, All pe rioperative data were collected on standardized forms. RESULTS: There were 182 cases (52%) of acute uncomplicated cholecystitis, 9 0 (26%) of gangrenous cholecystitis, 33 of hydrops (9.5%), and 43 of empyem a of the gallbladder (12.5%), Seventy six patients (22%) needed conversion to open cholecystectomy and complications occurred in 57 cases. Advanced ch olecystitis was associated with significant patient delay (P = 0.01), and i t had a significantly higher conversion rate (39%) compared with early chol ecystitis (14.5%); (P <0.00001). Conversion rates were also associated with male gender (P = 0.0017), a history of biliary disease (P = 0.0085), and a patient delay of >48 hours (P = 0.028), The total and infectious complicat ion rates were associated with an age older than 60 years (P = 0.023 and 0. 007, respectively) and male gender (P = 0.026 and 0.014, respectively), CONCLUSIONS: In acute cholecystitis, patient delay is associated with a hig h conversion rate. Early timing of laparoscopic cholecystectomy tends to re duce the conversion rate, as well as the total and the infectious complicat ion rates, Male gender, a history of biliary disease, and advanced cholecys titis are associated with conversion. Male and older patients are associate d with a high total and infectious complication rates. (C) 1999 by Excerpta Medica, Inc.