Predicting conversion from laparoscopic to open cholecystectomy presented as a probability nomogram based on preoperative patient risk factors

Janindu Goonawardena; Ronny Gunnarsson; Alan de Costa

doi:10.1016/j.amjsurg.2015.04.003

Predicting conversion from laparoscopic to open cholecystectomy presented as a probability nomogram based on preoperative patient risk factors

Am J Surg. 2015 Sep;210(3):492-500. doi: 10.1016/j.amjsurg.2015.04.003. Epub 2015 May 23.

Authors

Janindu Goonawardena¹, Ronny Gunnarsson², Alan de Costa³

Affiliations

¹ Cairns Clinical School, College of Medicine and Dentistry, James Cook University, Cairns Hospital, Cairns, Queensland, Australia.
² Cairns Clinical School, College of Medicine and Dentistry, James Cook University, Cairns Hospital, Cairns, Queensland, Australia; Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Research and Development Unit, Primary Health Care and Dental Care, Southern Älvsborg County, Region Västra Götaland, Sweden.
³ Cairns Clinical School, College of Medicine and Dentistry, James Cook University, Cairns Hospital, Cairns, Queensland, Australia; Department of Surgery, Cairns Hospital, Cairns, Queensland, Australia. Electronic address: alan.decosta@jcu.edu.au.

PMID: 26094149
DOI: 10.1016/j.amjsurg.2015.04.003

Abstract

Background: We aim to develop a risk stratification tool to preoperatively predict conversion (CONV) from a laparoscopic to open cholecystectomy.

Methods: Multiple risk factors were analyzed with multivariate logistic regression and presented as probability nomograms.

Results: Of 732 patients, 47 (6.4%) required CONV. Among 40 preoperative risk factors evaluated, 5 variables were found to have significant association with CONV: 2 clinical variables, previous upper abdominal surgery (odds ratio [OR] 95.2) and obesity defined as body mass index greater than 30 kg/m(2) (OR 12.3), and 3 ultrasound parameters, visible choledocholithiasis (OR 19.8), impacted stone at the neck of the gallbladder (OR 5.9), and gallbladder wall width in millimeters (OR 2.1). Nomograms based on this multivariate model demonstrate the individual preoperative probability of CONV. Internal validation using receiver operator curve analysis showed an area under the curve of .97.

Conclusion: Four probability nomograms were developed as a practical individual risk stratification tool to predict probability of CONV.

Keywords: Conversion; Laparoscopic cholecystectomy; Nomogram; Predict.

Publication types

Observational Study

MeSH terms

Abdomen / surgery
Adult
Aged
Cholecystectomy / methods*
Choledocholithiasis / complications
Choledocholithiasis / diagnostic imaging
Cholelithiasis / complications
Cholelithiasis / diagnostic imaging
Conversion to Open Surgery*
Female
Gallbladder / diagnostic imaging
Humans
Laparoscopy*
Longitudinal Studies
Male
Middle Aged
Multivariate Analysis
Nomograms*
Obesity / complications
Retrospective Studies
Risk Assessment*
Risk Factors
Ultrasonography