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Multicenter external validation of a nomogram predicting conversion to open cholecystectomy during laparoscopic surgery for acute calculous cholecystitis: a cross-sectional study

  • 0Department of Hepatobiliary Pancreatic Surgery, Huadu District People's Hospital of Guangzhou, Guangzhou, China. crazywu2007@126.com.
Scientific Reports +

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May 27, 2025

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May 27, 2025

View abstract on PubMed

Summary

This summary is machine-generated.

Predicting conversion from early laparoscopic cholecystectomy to open surgery in acute calculous cholecystitis patients is possible. Key risk factors include high C-reactive protein, calculus location, anesthesia classification, Tokyo Guidelines, and surgeon experience.

Area Of Science

  • Gastroenterology and Hepatobiliary Surgery
  • Surgical Oncology
  • Medical Informatics

Background

  • Acute calculous cholecystitis (ACC) often necessitates cholecystectomy.
  • Early laparoscopic cholecystectomy (ELC) is preferred, but conversion to open surgery can occur.
  • Predictive models for ELC to open conversion are crucial for surgical planning.

Purpose Of The Study

  • To identify and validate risk factors for converting ELC to open surgery in ACC patients.
  • To develop a predictive nomogram for intraoperative conversion risk.
  • To enhance surgical decision-making and patient management.

Main Methods

  • Retrospective analysis of 3,191 ACC patients undergoing ELC.
  • Least Absolute Shrinkage and Selection Operator (LASSO) regression for variable selection.
  • Binary logistic regression and nomogram development, validated with ROC curves, Hosmer-Lemeshow tests, and Decision Curve Analysis (DCA).

Main Results

  • Five key predictors identified: high preoperative C-reactive protein (CRP), gallbladder neck calculus, high American Society of Anesthesiologists (ASA) classification, high Tokyo Guidelines 2018 (TG18) classification, and junior surgeon.
  • The predictive model demonstrated moderate discrimination (AUC training: 0.868, AUC validation: 0.833).
  • The nomogram showed good calibration and potential clinical utility via DCA.

Conclusions

  • Preoperative CRP, calculus location, ASA and TG18 classifications, and surgeon seniority are significant predictors of ELC to open conversion in ACC.
  • The developed nomogram can aid surgeons in anticipating and managing conversion risks during ELC for ACC.
  • This predictive tool supports optimized surgical strategies and resource allocation.

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