Reply to Chen et al.

摘要

To the Editor—We really appreciate the interest of Dr. Chen and colleagues1 in our recent article.2 Several factors may explain the lower rate of laparoscopic cholecystectomy in our institutions. It is not the consequence of higher rates of conversion to open cholecystectomy, because we kept converted procedures in their original surgical group. First, note that our institutions adopted the National Nosocomial Infection Surveillance (NNIS) system's definition of operative procedure, which excludes outpatient (same-day) surgical procedures.3 Thus, same-day laparoscopic cholecystectomies were excluded from the analysis, lowering the overall proportion of laparoscopic procedures. Furthermore, our increasing use of same-day laparoscopic cholecystectomy in recent years, similar to increases in the use of this procedure elsewhere around the world, can account for the apparent reduction in the proportion of laparoscopic cholecystectomy observed in our series over time.