Impact of cardiovascular/diabetic comorbidity on conversion rate during laparoscopic cholecystectomy for acute cholecystitis: a multi-center study on early versus very delayed approach

Background. The impact of diabetes and cardiovascular comor- bidity on laparoscopic cholecystectomy has been long debated, evalua- ting them as risk factors for conversion to an open procedure especially in patients with acute cholecystitis: an “early” procedure, as suggested by 2013 Tokyo guidelines, has been compared to a “very delayed” one in patients under anticoagulant/antiplatelet therapy or treated for dia- betes and referred by medical wards to surgery after the acute period. Methods. We selected 240 patients operated for acute cholecystitis by laparoscopy over the last 4 years at St. Orsola University Hospital- Bologna and Umberto I University Hospital-Rome, comparing 98 diabetic/cardiovascular patients versus 142 subjects as control group: the selection was based on operative timing, “early” (73 patients trea- ted within 3 days) and “very delayed” (167 patients operated after 6 weeks). Results. In the “early” subgroup there was no difference compa- ring diabetic/cardiovascular patients (31 pts) versus control group (42 pts) while in the “very delayed” subgroup among diabetic/cardiovascu- lar patients (67 pts) there was significantly male predominance, ASA III/IV prevalence and less positive imaging findings versus control group (100 pts). In both subgroups, the conversion rate was significan- tly higher for diabetic/cardiovascular patients (“early”=25.8% and “very delayed”=8.95%) compared to control groups (“early”=4.76% and “very delayed”=1%), showing a trend (p=0.058) towards an in- creased conversion rate in the early approach among diabetic/cardio- vascular group. Conclusions. Our study showed a significantly increased conver- sion rate to an open cholecystectomy for diabetic/cardiovascular pa- tients affected by cholecystitis, especially within 3 days by the acute epi- sode.

The impact of diabetes and cardiovascular comorbidity on laparoscopic cholecystectomy has been long debated, evaluating them as risk factors for conversion to an open procedure especially in patients with acute cholecystitis: an "early" procedure, as suggested by 2013 Tokyo guidelines, has been compared to a "very delayed" one in patients under anticoagulant/antiplatelet therapy or treated for diabetes and referred by medical wards to surgery after the acute period.