Comparative Analysis of Elective Versus Emergency Cholecystectomy: A Study Using the Parkland Grading Scale, Nassar...

Introduction Laparoscopic cholecystectomy (LC) is a standard surgical procedure that general surgeons perform to treat acute cholecystitis. The presentation of this condition can vary in severity due to preoperative and intraoperative risk factors. Intraoperative scales such as the Parkland Grading Scale (PGS), Nassar Scale (NS), and G10 Score (G10S) evaluate these aspects. These scales help determine the severity of the condition, the need for conversion to open surgery, and the possibility of injury. However, their utility may differ between elective and emergency surgeries. Methods The objective of this study was to describe the clinical differences and intraoperative scales as well as the conversion rate to open surgery and the incidence of bile duct injury (BDI) in patients who underwent LC postoperatively at the Hospital Regional General Ignacio Zaragoza (HRGIZ) in Mexico City. An observational, descriptive, retrospective cross-sectional study was conducted. Patients over 18 years treated in the General Surgery Service of HRGIZ for LC between March 2022 and April 2023 were included. Pregnant patients and those undergoing other surgeries were excluded. The analyzed variables included age, gender, type of procedure, surgical time, scales (PGS, NS, G10S), conversion rate to open surgery, and BDI. Descriptive and inferential statistics were used for data analysis, including chi-square tests, Student's t-tests, and differences in proportions, utilizing VassarStats 2023 (Vassar College, Poughkeepsie, US) and Microsoft Excel v2401 (Microsoft Corp., Redmond, US). Results A total of 445 postoperative LC patients were identified. Based on the inclusion criteria, a sample of 364 patients was analyzed and classified into two groups: scheduled procedures (139, 38.2%) and emergency procedures (225, 61.8%). Both groups showed a female prevalence, with an average age of 55±16 years for scheduled procedures and 49±15 years for emergencies (p<0.05). No significant differences were found in surgical time, bleeding volume, or hospital stay between the groups. A higher number of LCs were performed as emergencies (205, 56.3%) compared to scheduled procedures (129, 35.4%) (p<0.0002). Of the total procedures, 4.3% required conversion to open surgery, and three patients (0.82%) presented with BDI. Regarding the evaluated scales, the PGS showed results of 2.51±1.42 in scheduled procedures compared to 3.49±1.34 in emergencies, the G10S score was 2.71±1.76 in scheduled procedures and 4.38±1.93 in emergencies, and the NS showed 1.91±0.92 in scheduled procedures and 3.02±0.90 in emergencies (p<0.05 for all). A higher percentage of BDI and a higher conversion rate to open surgery were noted in emergency procedures rather than scheduled procedures (3.02 vs. 1.37). Conclusions This study highlights the critical role of intraoperative scoring systems in predicting surgical difficulty and associated risks in LC. The significant differences in scores between elective and emergency surgeries reinforce their value in guiding surgical decision-making and tailoring approaches to individual patients. By integrating these scales into routine practice, surgeons can enhance outcomes, particularly in high-risk cases, while reducing complications such as BDI. Future research should focus on multi-institutional validation to further establish their utility in diverse clinical settings.