Laparoscopic cholecystectomy for acute cholecystitis: How do fever and leucocytosis relate to conversion and complications?

Objective: To find out whether fever and raised white cell count (WCC) are associated with conversion and complications of laparoscopic cholecystectom y in acute cholecystitis, and whether their presence could help in deciding the place of laparoscopic procedures. Design: Prospective study. Setting: Teaching hospital, Israel. Subjects: 256 patients who were treated for clinical acute cholecystitis be tween January 1994 and November 1997. Interventions: Emergency laparoscopic cholecystectomy. Main outcome measures: Raised temperature and WCC; incidence of conversion and complications. Results: Raised temperature (>38 degrees C) was independently associated wi th advanced cholecystitis (p = 0.002, odds ratio [OR] 2.7) and a palpable g allbladder preoperatively (p = 0.02, OR 2.1). Total complications correlate d with a temperature of >38 degrees C. Raised WCC(>15 x 10(9)/L) was indepe ndently associated with age >45 years (p = 0.02, OR 2.4), a palpable gallbl adder preoperatively (p = 0.001, OR 2.9), and a raised temperature (>38 deg rees C) (p < 0.0001, OR 6.2). Conversion was associated with a WCC >18 x 10 (9)/L (p = 0.01, OR 3.2). Conclusion: A WCC of >18 x 10(9)/L may assist in predicting conversion, and fever of >38 degrees C may assist in predicting the development of complic ations.