Y. Kim1, K. Wima1, B. T. Xia1, V. K. Dhar1, D. E. Go1, S. A. Shah1 1University Of Cincinnati,Surgery,Cincinnati, OH, USA
Introduction: Laparoscopic subtotal cholecystectomy (LSC) is considered a safe alternative to laparoscopic cholecystectomy (LC) if dissection of biliary anatomy is obscured. Recent reports have shown that morbidity rates are similar between the two procedures, but the impact of conversion on resource utilization has not been defined.
Methods: Using the University HealthSystem Consortium database, we identified 131,082 LC performed from 2009 to 2013, and 487 LSC performed during the same period. A 1:1 propensity score match was performed for 487 LSC procedures based on patient-level differences in clinical and demographic factors.
Results: Compared with LC, patients undergoing LSC were more likely to be male (54.2% vs. 32.3%), elderly (56 vs. 48 years), and have higher severity of illness (SOI) on admission (34.1% major or extreme SOI vs. 22.9%). LSC patients demonstrated a prolonged hospital length of stay (LOS, 4 days vs. 3 days), greater total direct cost ($9,053 vs. $6,398), higher readmission rates (11.9% vs 7.0%), and higher mortality rates (0.82% vs 0.28%, p<0.05 each). After matching, the difference in total direct cost persisted ($9,053 vs $7,581, p=0.0002), but there were no differences in hospital LOS, readmission rates, or overall mortality.
Conclusion: LSC is an important alternative to LC for difficult gall bladders in sicker patients. Our data demonstrate that patient-level factors are responsible for worse outcomes following conversion to LSC, and hospital outcomes are similar after adjusting for these factors.
