Predicting operative difficulty of laparoscopic cholecystectomy in patients with acute biliary presentations.

Abstract

BACKGROUND:

Early laparoscopic cholecystectomy (LC) is advocated in patients with an acute biliary presentation but may require some precaution. We aimed to assess the intra-operative difficulty of cholecystectomy in patients who underwent early intervention, and to establish a prediction model for a 'complicated' LC.

METHODS:

Retrospective analysis of prospectively collected data from patients presenting to the emergency department with acute biliary symptoms, and who subsequently underwent early LC between 2015 and 2018. Operative difficulty was assessed by standardized grading of intra-operative findings (grades 1-4). Pre-operative predictors for a 'complicated' LC (grades 3/4) were assessed using univariable and multivariable logistic regression analysis. A prediction model was created using variable regression coefficients. Cut-off and accuracy of the model were assessed using a receiver operating characteristic curve.

RESULTS:

A total of 185 patients were included and 59% presented with acute cholecystitis. In this cohort 113 (61%) patients underwent a 'complicated' LC. A prediction model for a 'complicated' LC (0-4.5 points) included: clinical diagnosis of acute cholecystitis (2 points), C-reactive protein >10.5 mg/L (1.5 points) and pericholecystic fluid on pre-operative imaging (1 point). A score ≥2.5 had a sensitivity of 77.7%, specificity of 81.7% and positive and negative predictive values of 87.0% and 69.9%, respectively.

CONCLUSION:

Early LC may be 'complicated' in up to 60% of cases. The presented prediction model uses readily available information in the emergency department and is a simple but accurate way to predict a likely 'complicated' LC in patients with acute biliary presentations.

• Authors: Sarah Z Wennmacker, Nazim Bhimani, Aafke H van Dijk, Thomas J Hugh, Philip R de Reuver
• Journal: ANZ journal of surgery (ANZ J Surg) Vol. 89 Issue 11 Pg. 1451-1456 (11 2019) ISSN: 1445-2197 [Electronic] Australia
• PMID: 31642165 (Publication Type: Journal Article)
• Copyright: © 2019 The Authors ANZ Journal of Surgery published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Surgeons.

Topics

• Adult
• Aged
• Cholecystectomy, Laparoscopic
• Cholecystitis, Acute (surgery)
• Female
• Forecasting
• Humans
• Intraoperative Complications (epidemiology)
• Male
• Middle Aged
• Preoperative Period
• Retrospective Studies