Abstract

BackgroundStudies focused on C‐reactive protein (CRP) as a marker of difficult laparoscopic cholecystectomy are limited to small case series. The aim of this study was to evaluate the association between preoperative CRP concentration and difficulty of laparoscopic cholecystectomy in patients admitted with a biliary emergency presentation.MethodsPatients with an emergency admission for biliary disease treated between 2012 and 2017 with a documented preoperative CRP level were analysed. Elective patients and those with other concurrent causes of increased CRP concentration were excluded. The intraoperative difficulty grade was based on the Nassar scale. Statistical analysis was conducted to determine the association of preoperative CRP level with difficulty grading, adjusted for the interval to surgery.ResultsA total of 804 emergency patients were included. The mean preoperative peak CRP level was 64·7 mg/l for operative difficulty grade I, 69·6 mg/l for grade II, 98·2 mg/l for grade III, 217·5 mg/l for grade IV and 193·1 mg/l for grade V, indicating a significant association between CRP concentration and Nassar grade (P < 0·001). Receiver operating characteristic (ROC) curve analysis showed an area under the curve of 0·78 (95 per cent c.i. 0·75 to 0·82), differentiating patients with grade I–III from those with grade IV–V operative difficulty. ROC curve analysis found a cut‐off CRP value of 90 mg/l, with 71·5 per cent sensitivity and 70·5 per cent specificity in predicting operative difficulty of grade IV or V. Logistic regression analysis found preoperative peak CRP level to be predictive of Nassar grade I–III versus grade IV–V operative difficulty, also when adjusted for timing of surgery (odds ratio 5·90, 95 per cent c.i. 2·80 to 12·50).ConclusionRaised preoperative CRP levels are associated with greater operative difficulty based on Nassar scale grading.

Highlights

  • The Japanese Society of Hepato-Biliary-Pancreatic Surgery developed the Tokyo Guidelines in 2007 to diagnose and grade the severity of acute cholecystitis based on local clinical signs (Murphy’s sign, right upper quadrant mass, pain and gallbladder tenderness), systemic signs of inflammation (fever, raised C-reactive protein (CRP) level and increased white cell count (WCC)) and imaging findings[1].Acute cholecystitis is a well recognized cause of difficult laparoscopic treatment

  • The aim of this study was to evaluate the association between preoperative CRP level and operative difficulty of emergency laparoscopic cholecystectomy in acute biliary admissions

  • Inclusion criteria for data analysis were: patient with biliary symptoms admitted as an emergency who underwent laparoscopic cholecystectomy and intraoperative cholangiography (IOC) with or without common bile duct (CBD) exploration, and a documented preoperative CRP value

Read more

Summary

Introduction

The Japanese Society of Hepato-Biliary-Pancreatic Surgery developed the Tokyo Guidelines in 2007 to diagnose and grade the severity of acute cholecystitis based on local clinical signs (Murphy’s sign, right upper quadrant mass, pain and gallbladder tenderness), systemic signs of inflammation (fever, raised C-reactive protein (CRP) level and increased white cell count (WCC)) and imaging findings[1].Acute cholecystitis is a well recognized cause of difficult laparoscopic treatment. The aim of this study was to evaluate the association between preoperative CRP concentration and difficulty of laparoscopic cholecystectomy in patients admitted with a biliary emergency presentation. Methods: Patients with an emergency admission for biliary disease treated between 2012 and 2017 with a documented preoperative CRP level were analysed. Elective patients and those with other concurrent causes of increased CRP concentration were excluded. Logistic regression analysis found preoperative peak CRP level to be predictive of Nassar grade I–III versus grade IV–V operative difficulty, when adjusted for timing of surgery (odds ratio 5⋅90, 95 per cent c.i. 2⋅80 to 12⋅50). Conclusion: Raised preoperative CRP levels are associated with greater operative difficulty based on Nassar scale grading

Objectives
Methods
Results
Conclusion
Full Text
Paper version not known

Talk to us

Join us for a 30 min session where you can share your feedback and ask us any queries you have

Schedule a call

Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.