Key result
Preoperative C-reactive protein demonstrated high accuracy (AUC 0.964) in predicting the need for conversion to open surgery during laparoscopic cholecystectomy for acute cholecystitis.
Why the study?
While preoperative CRP reflects inflammation, its predictive role in surgical outcomes for laparoscopic cholecystectomy remains debated.
Does preoperative CRP predict conversion to open surgery and complications in patients undergoing laparoscopic cholecystectomy for acute cholecystitis?
Cohort (n=180)
No
Does preoperative CRP predict conversion to open surgery and complications in patients undergoing laparoscopic cholecystectomy for acute cholecystitis?
Preoperative CRP is a highly accurate predictor of conversion to open surgery and postoperative complications in patients undergoing laparoscopic cholecystectomy for acute cholecystitis.
Answers are grounded in this paper and cite their sources.
Preoperative CRP may support risk stratification in acute cholecystitis; leaves open prospective validation before routine adoption.
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.
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Farahani et al. (2025) conducted a cohort in Acute cholecystitis and uncomplicated gallbladder stones (n=180). Preoperative C-reactive protein (CRP) was evaluated on Conversion from laparoscopic to open surgery (AUC 0.964). Preoperative C-reactive protein demonstrated high accuracy (AUC 0.964) in predicting the need for conversion to open surgery during laparoscopic cholecystectomy for acute cholecystitis.
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