Highlights
- •First study presenting a predictive model for probability of conversion as nomograms.
- •Two clinical variables, previous upper abdominal surgery and obesity, were significantly associated with conversion.
- •Three ultrasound variables, choledocholithiasis, impacted stone at the neck of the gallbladder, and gallbladder wall width, were significantly associated with conversion.
- •Four evidence-based probability nomograms were developed as a practical individual risk stratification tool to predict probability of conversion.
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/m2 (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
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Article info
Publication history
Published online: May 22, 2015
Received in revised form:
April 14,
2015
Received:
December 13,
2014
Footnotes
The authors declare no conflicts of interest.
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
