The national mortality burden and significant factors associated with open and laparoscopic cholecystectomy: 1997-2006

Introduction: This study aims to determine the mortality rate and significant factors associated with laparoscopic (LC) and open cholecystectomies (OC) over a 10-year period. Methods: Using the Nationwide Inpatient Sample, we analyzed data for both LC and OC between 1997 and 2006. Cholecystectomies performed as part of another primary procedure were excluded. Using procedure-specific codes, we calculated annual national volumes for both open and laparoscopic cholecystectomies for the time period under review and the associated in-hospital mortality following both of these procedures. Using logistic regression modeling, we then analyzed selected patient and institutional characteristics to determine if a significant association existed between these factors and in-hospital mortality. Results: There was a 16% increase in the volume of LC and a corresponding decrease in open procedures over the 10 years under review. In 2006, 12% of cholecystectomies were still performed using an open approach and the associated mortality remained significantly higher than that seen with LC. Overall, after adjusting for patient and hospital characteristics, the mortality for OC was higher than that for LC (OR 4.57; 95% CI, 4.37-4.79, p<0.001). Age (<60 years), male gender, non-elective admission, admission source, and a primary diagnosis other than cholelithiasis were all independently associated with increased mortality. The average mortality rate associated with conversion from LC to OC was found to be 0.7%. Conclusions: These data indicate an increase in the proportion LCs performed over the years under study with a decrease in the proportion of OCs. However, OCs remain associated with a significant mortality burden when compared with the laparoscopic approach.