Laparoscopic Cholecystectomy in Acute Cholecystitis: C-Reactive Protein Level Combined With Age Predicts Conversion

Introduction: The aim was to enable prediction of risk for conversion in early laparoscopic cholecystectomy for acute cholecystitis. Methods: Multivariate analysis and receiver operating characteristic curve analysis were used to define independent predictors for conversion and optimal cutoffs. Using those, a scoring system was created to predict conversion. Results: In 261 patients, conversion to open cholecystectomy was necessary in 62 cases (24%). Multivariate analysis revealed age and C-reactive protein (CRP) level to be independent predictors for conversion (odds ratio 1.02; P = 0.02 and odds ratio 1.01; P < 0.001). Using cutoffs obtained by receiver operating characteristic curve analysis resulted in an useful scoring system to predict conversion risk (age > 65 y = 1 + CRP value > 165 mg/L = 1): score 0 = 12%, 1 = 29%, 2 = 67% (P < 0.001). Conclusions: Higher age and elevated CRP level are independent predictors for conversion. Surgery for acute cholecystitis in patients with age > 65 years and/or CRP level > 165 mg/L should be considered as high risk for conversion.