ASSOCIATION FOR ACADEMIC SURGERY AND SOCIETY OF UNIVERSITY SURGEONS—ABSTRACTS388

it is sometimes difficult to grasp a global anatomic image due to thelimited scope field during the laparoscopic gastrectomy, dual-phase3D CT angiography is useful and essential modality to visualize pre-cise anatomy around stomach preoperatively and to perform safetytreatment.

54.16. Happiness with Operative Conduct Correlates withSelf-Rates Surgeon Personality Characteristics. P. A.Knoll, J. J. Stulberg, B. Champagne, H. Reynolds, Jr, C. P.Delaney, E. L. Marderstein; University Hospitals CaseMedical Center, Cleveland, OH

Introduction: Scales to predict postoperative complications are gen-erally derived from easy to measure preoperative laboratory valuesand intraoperative conduct is given insufficient weight. While subjec-tive ratings by surgeons of their happiness with operative conduct foran individual operation may predict the likelihood of a postoperativecomplication, individual surgeon personality may strongly affectthese measures. The purpose of this study was to demonstrate the ef-fect of surgeon personality on happiness with operative conduct.Methods: As part of an ongoing study of postoperative complications,the 4 surgeons in the Division of Colorectal Surgery are asked to ratetheir level of happiness with operative conduct and their level of hap-piness with staff/equipment at the conclusion of each surgical proce-dure. Personality testing was performed using the validatedinstruments: Big Five Inventory Version 54 and the Oxford Happi-ness Questionnaire. Correlation was performed between the postop-erative ratings and the personality testing. Results: Surgeonhappiness with operative conduct was recorded for a cohort of 131 pa-tients and averaged 7.8 out of 10. Surgeon happiness with staff/equip-ment averaged 8.1 out of 10. As expected for the Big Five Inventory,surgeons self-rated highest on the scale for conscientiousness (mean4.4 of 5) and slightly lower on the scales for extraversion, agreeable-ness, openness and neuroticism (3.5-3.8 of 5). Surgeon happinesswith operative conduct correlated best with their self-rated conscien-tiousness (R2¼ 0.65) but there was no correlation with the other per-sonality domains. Surgeon happiness with staff/equipment alsocorrelated well with their self-rated conscientiousness (R2¼ 0.95)and inversely with self-rated neuroticism (R2¼ 0.60) but did not cor-relate with the other domains. Surgeon happiness with operative con-duct correlated well with self-rated overall happiness on the Oxfordscale (R2¼ 0.62). Within the domains of this scale, self-rated life sat-isfaction (R2¼ 0.81) and calmness (R2¼ 0.85) showed particularly ro-bust correlation with surgeon happiness with operative conduct. By

contrast, surgeon happiness with staff/equipment had only a fair cor-relation with self-rated overall happiness on the Oxford scale. Theself-rated calmness domain (R2¼ 0.87) had an excellent correlationwith happiness with staff/equipment while all other domains didnot correlate well. Conclusions: Surgeon self-rated conscientious-ness and calmness was strongly associated with level of happinesswith operative conduct and level of happiness with staff/equipment.Self-rated neuroticism had a moderate inverse relationship with sur-geon happiness with staff/equipment. Surgeon self-rated overall hap-piness correlated well with surgeon happiness with operativeconduct. Surgeon self-perception and personality influence their feel-ings about operative conduct. Differences in personality may accountfor some of the variability in measures of surgeon happiness at thecompletion of an operation.

54.17. The Impact of Endoscopic Retrograde Cholangiopan-creaticography on Length of Stay. R. C. Britt, T.Novosel, L. Weireter, S. F. Reed, J. N. Collins, L. Britt;Eastern Virginia Medical School, Norfolk, VA

Background: Endoscopic retrograde cholangiopancreaticography(ERCP) performed either before or after laparoscopic cholecystectomy(LC) is a commonly used modality for the management of choledocho-lithiasis. We assess the impact of pre and post-operative ERCP onlength of stay. Methods: A retrospective review was done of a prospec-tively collected database encompassing all patients with biliary dis-ease admitted to the Acute Care Surgery Service over two years.Diagnosis, operations performed, time from admission to operation,length of stay (LOS), and complications were assessed. Results: 190patients with biliary disease were operated on, with 22 having preopERCP and 26 postop. There was no difference in the age or co morbid-ities between the three groups. The patients who did not requireERCP had a significantly shorter LOS (4.9 vs 9.1 days, p< 0.0001)as well as a significantly shorter time from admission to operation(55.3 vs. 84.3 hours, p< 0.01). There was no significant difference inthe LOS for the pre versus postoperative ERCP groups (8.6 vs. 9.6days, p¼ 0.75), but the post-operative ERCP group had a significantlyshorter time for admission to operation (64.6 vs. 106.6 hours,p< 0.02). No patients had an unsuccessful post-operative ERCP. 34of the 142 patients who did not need ERCP had a negative intraoper-ative cholangiogram, with three patients having choledocholithiasison cholangiogram treated with laparoscopic common bile duct explo-ration and clearance. The 37 patients who had intraoperative cholan-giogram did have a significantly shorter LOS (5.3 vs 9.1, p< 0.04) anda trend towards shorter time from admission to operation (67.6 vs.84.3 hours, p¼ 0.25) than the patients requiring ERCP. Conclusion:The need for ERCP significantly lengthens hospital length of stay andtime from admission to operation. An appropriate treatment algo-rithm for suscepted choledocholithiasis may be laparoscopic cholecys-tectomy with intraoperative cholangiogram and possible attempt atlaparoscopic stone clearance, followed by judicious use of ERCP asnecessary.

54.18. Laparoscopic Cholecystectomy Conversion Rates TwoDecades Later: An Analysis of Surgeon and Patient-Specific Factors Resulting in Open Conversion. S. V.Sakpal, S. S. Bindra, C. Paruthi, R. S. Chamberlain; SaintBarnabas Medical Center, Livingston, NJ

Background: Although we are more than two decades into the lap-aroscopic era, nationwide laparoscopic cholecystectomy (LC) conver-sion rates remain in excess of 10% in some series.1 We sought toanalyze patient-specific features in converted LCs, and determinethe impact of surgeon-specific factors on conversions. Methods: Atotal of 2,205 LCs (74.7% female and 25.3% males; average age of50.5 years [range 1-96]) performed at a large tertiary communityhospital over a 5-year period (May 2004-October 2008) were ana-lyzed retrospectively. Results: The overall conversion rate for thestudy period was 4.94%. The number of cholecystectomies peaked