TPTh 7.09 Predictors of Difficult Cholecystectomy Using Admission-to-Operation Timing and Their Impact on Outcomes: A Single-Centre Cohort Analysis

Abstract

Anticipating a difficult cholecystectomy is essential for theatre planning and patient counselling. This study evaluated whether prior diagnosis status, disease severity, surgical indication, and admission-to-operation timing (categorised in 24-hour bins) could predict surgical difficulty. Additionally, the predictive value of white cell count (WCC), C-reactive protein (CRP), and National Early Warning Score (NEWS) at presentation, along with pre-operative ERCP, was assessed alongside post-operative complications and length of stay (LOS). This retrospective single-centre cohort included 212 consecutive cholecystectomies. A "difficult" case was defined as any operation other than standard laparoscopic cholecystectomy (LC) or LC with intra-operative cholangiogram (IOC), or any case requiring a post-operative drain. Logistic regression was utilised to identify independent predictors, while LOS (median/IQR) and complications were compared between difficult and non-difficult groups. Independent predictors of difficulty were disease severity (OR 7.78, 95% CI 3.28–18.43, p<0.001), admission CRP (OR 1.007, p=0.004), and acute cholecystitis (OR 8.02, p<0.001). Notably, admission-to-operation timing (per 24-hour bin) was not significant (p=0.269). Difficult cases were associated with a significantly longer median LOS (8 vs. 4 days; p=0.0016) and a higher borderline complication rate (11.6% vs. 4.8%; p≈0.063). Univariate difficulty rates varied by indication, peaking at 60.0% for acute cholangitis and 57.1% for acute cholecystitis. Greater disease severity, elevated CRP, and an indication of acute cholecystitis independently predict a difficult cholecystectomy, whereas the timing of the operation from admission does not. Difficult procedures are associated with substantially increased hospital stays and a trend toward higher complication rates.