Retrospective Validation of Parkland Grading Scale in a Latin American High-Volume Center

Abstract

INTRODUCTION: Cholecystitis accounts for more than 12% of emergency general surgery. An increase in the proportion of laparoscopic cholecystectomy leading to higher complication rate has been described, probably related to variables such as operative difficulty, anatomical variation, and gallbladder inflammation severity. Parkland Grading Scale (PGS) is used to stratify cholecystitis severity to predict operative difficulty and anticipate potential complication. This study aims to validate PGS as a postoperative-outcomes predictive tool, comparing its performance with the Tokyo Guidelines Grading System (TGGS). METHODS: Single-center retrospective cohort study that analyzed intraoperative and postoperative outcomes of laparoscopic cholecystectomy in association with PGS and TGGS. Univariate and bivariate analyses were performed for each severity grading scale using STATA SE 16.0 software. Logistic regression models for each scale were proposed, and their association with outcomes was evaluated and compared between both scales by their receiver operator characteristic (ROC). RESULTS: A total of 1,098 patients were included. Grade 1 predominance was observed for PGS and TGGS (47.36% and 25.3%, respectively). A positive association was observed between higher PGS grade and inpatient postoperative management, hospitalization time, ICU requirement, and antibiotic use. Based on the area under the ROC, better performance was observed for PGS than for TGGS in all the evaluated outcomes. CONCLUSION: PGS showed better performance than TGGS as a predictive tool for inpatient postoperative management, length of hospitalization, ICU, and antibiotic requirement, especially for severe cases.