Preoperative prediction model for critical view of safety achievement in laparoscopic cholecystectomy: a retrospective cohort study.

BACKGROUND

We developed and validated a preoperative model to predict the difficulty in achieving the critical view of safety (CVS) during laparoscopic cholecystectomy (LC).

METHODS

Patients who underwent LC with preoperative computed tomography (CT) and magnetic resonance cholangiopancreatography between January 2015 and December 2023 were retrospectively analyzed and randomly assigned to derivation and validation cohorts (8:2). Surgical difficulty was defined as failure to achieve CVS. Logistic regression analysis was used to identify independent predictors. Model performance was evaluated using the area under the receiver operating characteristic curve and Brier score.

RESULTS

Independent preoperative risk factors included age ≥ 65 years, American Society of Anesthesiologists physical status ≥ 3, preoperative endoscopic gallbladder drainage or stenting, CT attenuation of the CVS window ≥ - 26 HU, and common bile duct disruption on magnetic resonance cholangiopancreatography (all p < 0.05). The prediction score (0-13) demonstrated an area under the receiver operating characteristic curve of 0.732 (95% confidence interval 0.528-0.936) in the validation cohort. Risk stratification identified low-, moderate-, and high-risk groups with increasing rates of failure to achieve CVS.

CONCLUSIONS

This preoperative imaging-based scoring system may help predict CVS failure in LC and guide surgical decision-making.