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Introduction and objectives <p>Laparoscopic cholecystectomy (LC) is the standard treatment for gallstone disease, although it may involve high technical complexity. A predictive scale was developed and internally validated based on preoperative variables to anticipate surgical difficulty, aiming to support surgical planning, facilitate efficient resource allocation, and improve patient safety.</p> Materials and methods <p>A retrospective case-control study was conducted across three secondary and tertiary care hospitals in the Lagunera region of Coahuila and Durango, Mexico. The manuscript was prepared following STROBE guidelines. Patients who underwent LC between February 2022 and May 2025 were included. Preoperative variables analyzed included age, sex, diabetes mellitus, neutrophil-to-lymphocyte ratio (NLR), indirect bilirubin (IB), and systemic inflammatory index (SII), in relation to surgical difficulty (Parkland grade ≥ 4). A binary logistic regression model and a proportional scoring scale were developed. Only patients with complete data were included. In a sensitivity analysis, the inclusion of SII improved sensitivity without affecting specificity.</p> Results <p>A total of 250 patients were analyzed. The five-variable model yielded an AUC of 0.825, with 54.8% sensitivity and 89.4% specificity. Incorporating SII increased sensitivity to 77.8% without reducing specificity (85.9%). The final scale, including six dichotomous variables and a cutoff score of 7, achieved an AUC of 0.89.</p> Conclusions <p>The proposed scale anticipates surgical difficulty in LC using inflammatory biomarkers and simple clinical data. Its implementation may improve surgical planning and safety, even in resource-limited settings.</p> Graphical abstract <p></p>

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Anticipating surgical complexity in laparoscopic cholecystectomy: a clinical score based on inflammatory markers

  • 期刊论文

  • 发表日期：

    2026年1月8日

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  • Erick Moreno Delgado,
  • Edwin Leopoldo Maldonado García,
  • Jorge Luis Vargas Lugo,
  • Carlos Ignacio Martínez Huerta,
  • Estefanía Méndez Herrera,
  • Daniela Martínez de León León,
  • Ricardo Antonio Martínez Rivera Rivera

摘要

Introduction and objectives

Laparoscopic cholecystectomy (LC) is the standard treatment for gallstone disease, although it may involve high technical complexity. A predictive scale was developed and internally validated based on preoperative variables to anticipate surgical difficulty, aiming to support surgical planning, facilitate efficient resource allocation, and improve patient safety.

Materials and methods

A retrospective case-control study was conducted across three secondary and tertiary care hospitals in the Lagunera region of Coahuila and Durango, Mexico. The manuscript was prepared following STROBE guidelines. Patients who underwent LC between February 2022 and May 2025 were included. Preoperative variables analyzed included age, sex, diabetes mellitus, neutrophil-to-lymphocyte ratio (NLR), indirect bilirubin (IB), and systemic inflammatory index (SII), in relation to surgical difficulty (Parkland grade ≥ 4). A binary logistic regression model and a proportional scoring scale were developed. Only patients with complete data were included. In a sensitivity analysis, the inclusion of SII improved sensitivity without affecting specificity.

Results

A total of 250 patients were analyzed. The five-variable model yielded an AUC of 0.825, with 54.8% sensitivity and 89.4% specificity. Incorporating SII increased sensitivity to 77.8% without reducing specificity (85.9%). The final scale, including six dichotomous variables and a cutoff score of 7, achieved an AUC of 0.89.

Conclusions

The proposed scale anticipates surgical difficulty in LC using inflammatory biomarkers and simple clinical data. Its implementation may improve surgical planning and safety, even in resource-limited settings.

Graphical abstract