Clinical ScienceHow to predict difficult laparoscopic cholecystectomy? Proposal for a simple preoperative scoring system

•Operative difficulty for laparoscopic cholecystectomy is hard to predict.•Deviations from the standard operative time were used to compare procedures.•The score for difficult laparoscopic cholecystectomy (DiLC score) was generated.•Area under the ROC curve was .80, and a diagnostic accuracy was 75.5%.•The simplicity of the DiLC score makes it easy to integrate into clinical practice.

BackgroundFew studies have used operative time as a reflection of the surgical difficulty to create a preoperative score of operative difficulty in laparoscopic cholecystectomies (DiLCs score).MethodsPatients who benefited from cholecystectomy between 2010 and 2015 were reviewed. Difficult procedures were identified using the deviations from the operative time for simple cholecystectomies. Logistic regression analyses were carried out to build risk-assessment models and derive the DiLC score.ResultsOverall, 644 patients were identified. Multivariate analyses identified male sex, previous cholecystitis attack, fibrinogen, neutrophil, and alkaline phosphatase count to be predictive of operative difficulties. Risk-assessment model was generated with an area under the receiver-operator curve of .80. Internal validation was performed using the bootstrap method.ConclusionsThe DiLC score is a simple and reliable tool which could be used to improve patient counseling, optimize surgical planning, detect procedures at risk, identify patients eligible for outpatient care, and enhance resident training.