Validation of a nomogram with inflammation-based markers developed to predict difficult laparoscopic cholecystectomy in patients with acute cholecystitis.

PURPOSE: To identify the predictors of difficult laparoscopic cholecystectomy (LC) in patients with acute cholecystitis (AC) and to develop a corresponding nomogram.

METHODS

In this retrospective study, we divided patients who underwent LC for acute cholecystitis into a training cohort (223 patients) and a validation cohort (88 patients). We defined difficult LC (DLC) as that resulting in blood loss ≥ 50 mL, operative time ≥ 150 min, or conversion to open surgery (DLC group).

RESULTS

In the training cohort, the postoperative complication incidence and hospitalization duration were greater in the DLC group than in the non-DLC group (n = 130; 58.3% vs. n = 93; 41.7%, respectively). Multivariate analysis identified male sex, preoperative Glasgow Prognostic Score ≥ 1, neutrophil-to-lymphocyte ratio ≥ 6.75, symptom duration ≥ 72 h, and pericholecystic fat hyperdensity on computed tomography (CT) as independent predictors of DLC. The corresponding nomogram showed good discrimination (area under the curve of 0.806), with 77.55% sensitivity and 72.1% specificity, acceptable calibration, and clinical utility according to decision curve analysis.

CONCLUSION

Our nomogram predicts DLC reliably and could be used for preoperative risk assessment and surgical treatment planning.