Validation of the Nassar Preoperative Risk Scale to Predict Intraoperative Difficulty in Patients Undergoing Laparoscopic Cholecystectomy

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BackgroundLaparoscopic cholecystectomy (LC) is one of the most commonly performed surgical procedures worldwide.Although generally safe, a subset of procedures may become technically challenging due to various intraoperative factors.Difficult LC is associated with increased operative time, higher complication rates, and greater risk of bile duct injury.Preoperative prediction of operative difficulty may allow better surgical planning and allocation of experienced surgeons.The Nassar Preoperative Risk Scale has been proposed as a tool to predict difficulty in LC; however, validation in different populations remains limited.This study aimed to evaluate the predictive accuracy of the Nassar Preoperative Risk Scale in predicting difficult LC. MethodsA hospital-based analytical cross-sectional study was conducted from November 2024 to March 2025 among patients undergoing LC.Consecutive patients aged 18-80 years with calculous cholecystitis undergoing LC were included.The Nassar Preoperative Risk Scale was calculated for each patient.Intraoperative difficulty was assessed using the Nassar intraoperative difficulty grade.Receiver operating characteristic (ROC) analysis was performed to determine the optimal cut-off value and evaluate the predictive performance of the scale. ResultsA total of 572 patients were included in the study.Easy intraoperative findings were observed in 87.24% of cases, while 12.76% were classified as difficult.ROC analysis demonstrated good predictive performance of the Nassar Preoperative Risk Scale, with an area under the curve (AUC) of 0.884.The sensitivity was 76.7%, specificity was 87.8%, and overall predictive accuracy of the scale was 86.4%.The positive predictive value (PPV) was 47.86%, and the negative predictive value (NPV) was 96.26%. ConclusionsThe Nassar Preoperative Risk Scale demonstrated good predictive accuracy in identifying difficult LC. Preoperative risk stratification using this scoring system may help surgeons anticipate operative challenges, improve surgical planning, and enhance patient safety.