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Acute calculous cholecystitis : Risk factors for conversion and complications

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Title: Acute calculous cholecystitis : Risk factors for conversion and complications
Author(s): Terho, Petra
Contributor: University of Helsinki, Faculty of Medicine
Discipline: Gastroenterological Surgery
Language: English
Acceptance year: 2016
Abstract:
BACKGROUND The purpose of the study was to identify risk factors for conversion of laparoscopic cholecystectomy and risk factors for postoperative complications in acute calculous cholecystitis. The most common complications arising from cholecystectomy were also to be identified. METHODS 400 consecutive patients, who had undergone non-elective laparoscopic or open cholecystectomy for acute calculous cholecystitis in Meilahti Hospital in 2013-2014, were included into analysis. The Clavien-Dindo classification of surgical complications was used. RESULTS 373 (93.2%) patients had laparoscopic cholecystectomy initiated of which 84 (22.5%) were converted to open surgery. 27 patients had surgery initiated as open cholecystectomy. Multivariate logistic regression identified CRP over 150 mg/l, age over 65 years, diabetes, gangrene of the gallbladder and an abscess as risk factors for conversion. 76 (19.0%) patients experienced complications. Multivariate logistic regression identified age over 65 years, male gender, impaired renal function and surgery finished as open cholecystectomy as risk factors for complications. CONCLUSIONS Advanced cholecystitis with high CRP, gangrene or an abscess increase the risk of conversion. The risk of postoperative complications is higher after open cholecystectomy. Early identification and treatment of acute calculous cholecystitis might reduce the number of patients with advanced cholecystitis and thus improve outcomes.


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