Preoperative C-reactive protein as a predictor of conversion and complications in laparoscopic cholecystectomy for acute cholecystitis.

INTRODUCTION

Laparoscopic cholecystectomy (LC) is the gold standard for gallbladder surgery but may require conversion to open surgery in complicated cases. While preoperative C-reactive protein (CRP) is known to reflect inflammation, its predictive role in surgical outcomes remains debated. This study evaluated CRP as a predictor of surgical outcomes in acute cholecystitis and uncomplicated gallbladder stones, explicitly excluding choledocholithiasis to isolate gallbladder-specific inflammatory predictors.

MATERIALS AND

METHODS

This retrospective cohort study analyzed 180 patients undergoing LC for acute cholecystitis (n = 76), chronic cholecystitis (n = 14), or uncomplicated cholelithiasis (n = 90). Preoperative CRP levels were measured, and ROC analysis determined optimal thresholds for predicting conversion and complications (hydrops, necrosis, phlegmon, abscess, bleeding). Due to incomplete albumin data (17.8% missing), the CRP-to-albumin ratio (CAR) could not be robustly analyzed; thus, CRP was the primary focus. Patients with common bile duct (CBD) stones (n = 32) were excluded to eliminate confounding biliary obstruction. Demographic and clinical data of the patients were recorded, and statistical analysis was performed using R software.

RESULTS

Acute cholecystitis patients had higher CRP (25.4 vs. 7.1 mg/L, p < 0.001), longer hospital stays (7.4 vs. 2.2 days, p = 0.001), and more complications (e.g., necrosis: 16.7% vs. 1.1%, p < 0.001). CRP predicted conversion to open surgery with Area Under the Curve (AUC) 0.964 (optimal threshold: 7.5 mg/L, sensitivity 100%) and complications (AUC 0.899-0.983). Chronic cholecystitis patients had lower CRP (4.2 mg/L) and no conversions.

CONCLUSIONS

CRP demonstrated high accuracy (AUC 0.964) in predicting conversion and complications in acute cholecystitis, with thresholds actionable for surgical planning. Its utility in uncomplicated cholelithiasis is limited.