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.