Nationwide trends in the use of subtotal cholecystectomy for acute cholecystitis

Subtotal cholecystectomy is a viable alternative approach to the proverbial “difficult” gallbladder. To date, only a few studies have observed the establishment of those bail-out procedures as an increasingly common surgical practice. The purpose of this study is to assess nationwide trends of subtotal cholecystectomy through evaluation of operative variables and patient- and institution-level characteristics in procedure preference. Data were obtained from the National Inpatient Sample for the years between 2003 and 2014. Patients with acute cholecystitis were categorized based on the ninth revision International Classification of Disease Clinical Modification procedure codes for open total, laparoscopic total, open subtotal, or laparoscopic subtotal cholecystectomy. Any patient younger than 18 years of age or with a preoperative stay >1 week was excluded. Logistic regression analysis was performed to evaluate significant patient- and institution-level characteristics associated with the performance of subtotal cholecystectomy. A total of 290,855 patients were evaluated. During the study period, the rate of open and laparoscopic subtotal cholecystectomy sharply increased (0.10% of all cholecystectomy procedures to 0.52% and 0.12% to 0.28%, respectively). The conversion rate from laparoscopic to open total cholecystectomy decreased from 10.5% to 7.6%. Subtotal cholecystectomies were performed at significantly higher rates in men (odds ratio: 1.95, P < .001), Asian Americans (odds ratio: 2.21, P = .037), and patients with alcohol abuse (odds ratio: 2.23, P < .001). Teaching hospitals (odds ratio: 2.41, P < .001) and those in rural areas (odds ratio: 2.26, P < .001) were more likely to perform subtotal cholecystectomies. Growing trends in the use of subtotal cholecystectomy suggest evolving surgical practices for acute cholecystitis. Our data suggests that several patient- and hospital-level characteristics might play a deciding role in procedure preference.