Provincial Cholecystectomy Conversion Rates
The objective of this project is to measure the provincial cholecystectomy conversion rate variance and its impact on whether the general surgeons of Alberta modify their own practice based on observed variance.
Dr. Chris de Gara, Professor of Surgery, University of Alberta
General surgeons in Alberta who perform cholecystectomies.
Background and Rationale
Over eight thousand cholecystectomies are performed annually in Alberta. Generally, they are done laparoscopically; however, this technique is occasionally abandoned in favour of the more traditional open approach because of unexpected findings at the time of surgery. The incision length and discomfort associated with open approach extends patient hospital stay from 1-2 days to 5-7 days.
General surgeons are the only group who perform this procedure. Variance exists in the degree of conservatism that should be adopted in performing cholecystectomies. Some continue with the traditional strategy and treat all patients with a plan for elective surgery. Others perform emergency surgery within a matter of hours of patient admission; the argument is that when the gallbladder is acutely inflamed, tissue planes are easier to dissect. However, an open conversion rate is higher in emergency surgery than in elective surgery.
Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). (2010). Guidelines for the clinical application of laparoscopic biliary tract surgery. Los Angeles, CA: SAGES.
Papandria, D., Lardaro, T., Rhee, D., Ortega, G., Gorgy, A., Makary, M. A., & Abdullah, F. (2013). Risk factors for conversion from laparoscopic to open surgery: analysis of 2138 converted operations in the American College of Surgeons national surgical quality improvement program. The American surgeon, 79(9), 914–921.
Lee, N. W., Collins, J., Britt, R., & Britt, L. D. (2012). Evaluation of preoperative risk factors for converting laparoscopic to open cholecystectomy. The American surgeon, 78(8), 831–833.
Le, V. H., Smith, D. E., & Johnson, B. L. (2012). Conversion of laparoscopic to open cholecystectomy in the current era of laparoscopic surgery. The American surgeon, 78(12), 1392–1395.
Lipman, J. M., Claridge, J. A., Haridas, M., Martin, M. D., Yao, D. C., Grimes, K. L., & Malangoni, M. A. (2007). Preoperative findings predict conversion from laparoscopic to open cholecystectomy. Surgery, 142(4), 556–563; discussion 563–565.