Related Experiment Video
Updated: Jan 21, 2026
Author Spotlight: Advancing Early Detection and Treatment of Gastrointestinal Tumors
Published on: February 16, 2024
A predictive grading scale for acute cholecystitis
Sammy Siada1, David Jeffcoach1, Rachel C Dirks1
1Department of Surgery, University of California San Francisco Fresno Center for Medical Education and Research, Fresno, California, USA.
Background:
Acute cholecystitis presents in a spectrum of severity, where acute disease may be complicated by severe inflammation, gangrene, and perforation. The goal of this study is to outline an evidence-based grading scale that predicts patient outcomes after laparoscopic cholecystectomy (LC).
Methods:
A retrospective review of all patients with a preoperative diagnosis of acute cholecystitis who underwent LC from August 2011 until June 2015 at a tertiary-level hospital was performed. Patients who underwent elective cholecystectomy, incidental cholecystectomy, a planned open cholecystectomy, had gallstone pancreatitis or choledocholithiasis, and those admitted to a non-surgical service were excluded. Severity of disease was obtained from operative and pathology reports, and patients were classified according to the following grading scale:Grade I: symptomatic cholelithiasis.Grade II: acute/chronic cholecystitis.Grade III: gangrenous/necrotizing cholecystitis.Grade IV: gallbladder perforation or abscess.The groups were compared on age, gender, body mass index, severity of gallbladder disease, presence of preoperative systemic inflammatory response syndrome, hospital length of stay, length of operation, complications within 30 days, conversion to open rate, and cost of hospitalization.
Results:
During the study period, 1252 patients who underwent laparoscopic cholecystectomy were analyzed; 677 met inclusion criteria. The most common grade was grade 2, which was present in 80% of patients, followed by grade 3, which was found in 16% of patients. Grade 4 cholecystitis occurred in 1.2% of patients and grade 1 occurred in 3.2% of patients. There were statistically significant increases in age, presence of preoperative systemic inflammatory response syndrome, hospital length of stay, conversion to open rate, cost of hospitalization, and length of operation with increased cholecystitis grade.
Conclusions:
The proposed grading scale is an accurate predictor of duration of operation, conversion to open rate, hospital length of stay, and cost of hospitalization.
Level Of Evidence:
III.
Study Type:
Prognostic.
Related Concept Videos
01:19Graded Potential
Graded potentials fall into two categories: depolarizing and hyperpolarizing. Depolarizing graded potentials typically occur when sodium (Na+) or...
02:27Predicting Molecular Geometry
02:41pH Scale
01:15Types of Aggregate Grading
Well-graded aggregates include a complete range of necessary size fractions that fit together to create a dense matrix with minimal voids, represented by a smooth, continuous gradation curve. This type of grading ensures good...
01:19Sieve Analysis and Grading Curves
01:03Prediction Intervals
However, the point estimate is most likely not the exact value of the population parameter, but close to it. After calculating point estimates, we construct interval estimates, called confidence intervals or prediction intervals. This prediction interval comprises a range of values unlike the point estimate and is a better predictor of the observed sample value, y.