Clinical Significance of the Parkland Grading Scale in Laparoscopic Cholecystectomy: Association With Operative Difficulty and Post-Operative Outcomes

Objectives: To assess the correlation between Parkland Grading Scale and operative time, postoperative complications, drain placement, and hospital stay in patients who underwent laparoscopic cholecystectomy. Methods: This was a prospective observational study carried out in the Department of General Surgery, a tertiary care teaching hospital from January 2024 to December 2025. By consecutive sampling, a total of 150 adult patients undergoing laparoscopic cholecystectomy were included. The Parkland Grading Scale was evaluated intraoperatively right after the initial laparoscopy visualization of the gallbladder and prior to extensive manipulation and dissection. Operative time, postoperative complications, drain placement, hospital stay and surgical difficulty score were recorded. One-way ANOVA, Chi-square test and Pearson's correlation analysis were used to evaluate association among Parkland grade and perioperative outcomes. Results: Grade III was the most frequently observed Parkland grade (47, 31.3%), followed by Grade II (44, 29.3%) and Grade I (34, 22.7%). Mean operative time increased progressively from 44.53 ± 6.02 minutes in Grade I to 125.60 ± 13.96 minutes in Grade V (F=72.48, p<0.001), while mean hospital stay increased from 1.47 ± 0.51 to 7.40 ± 0.89 days, respectively (F=95.74, p<0.001). Postoperative complications increased from 2.9% in Grade I to 40.0% in Grade V (χ²=16.32, p=0.003), and drain placement increased from 5.9% to 80.0% (χ²=31.85, p<0.001). Parkland grade had strong positive correlation with operative time (r=0.842), hospital stay (r=0.881), and surgical difficulty score (r=0.903), all of which had p<0.001. Multivariable logistic regression revealed that Parkland grade was a significant predictor of postoperative complications (OR=3.84, 95% CI: 1.92–7.68; p<0.001) and prolonged hospitalization (OR=5.71, 95% CI: 2.44–13.37; p<0.001). Conclusion: There was a significant relationship between higher Parkland grades and longer operative time, more postoperative complications, more drains and longer hospital stay. The Parkland Grading Scale was well correlated with the operative difficulty and short-term postoperative outcomes and can be a simple and useful tool to predict the perioperative needs of patients undergoing laparoscopic cholecystectomy.