title: A risk score to predict the difficulty of elective laparoscopic cholecystectomy.
abstract: BACKGROUND
  Several preoperative scoring systems have been proposed to predict the difficulty of laparoscopic cholecystectomy in order to optimize the results of surgical treatment by either selection of patients for the procedure or providing an adequately experienced surgical team for a given patient. Nevertheless, none of them has achieved significant penetration into everyday practice.
  
  
  OBJECTIVE
  To propose and validate a novel risk score based on the patient's history, physical examination and abdominal ultrasonography parameters.
  
  
  METHODS
  The risk score was defined by the presence of the following risk factors: male sex, biliary colic within the last 3 weeks prior to surgery, history of acute cholecystitis treated conservatively, previous upper abdominal surgery, right upper quadrant pain, rigidity in right upper abdomen and ultrasonographic parameters - thickening of the gallbladder wall ≥ 4 mm, hydropic gallbladder (diameter exceeding 4.5 cm) and shrunken gallbladder. One point was allocated for each risk factor, except for previous upper abdominal surgery, which scored two. Difficulty of the surgery was assessed by operating time (OT) and the postoperative subjective evaluation score (PSES).
  
  
  RESULTS
  Five hundred and eighty-six consecutive patients were enrolled in the prospective observational study. A significant linear correlation was observed between the risk score and measures of difficulty employed. Five levels of difficulty were defined (score 0, 1, 2, 3, ≥ 4) with significant differences in OT, PSES and conversion rates (p < 0.001).
  
  
  CONCLUSIONS
  The suggested risk score is designed as a simple and reliable predictive model, possibly effective to overcome the negative effect of the individual proficiency gain curve and/or to select 'easy' cases for day surgery, single incision laparoscopic surgery or natural orifice translumenal endoscopic surgery procedures.
authors.affiliation: 1 Department of Surgery, University of Pavol Jozef Safarik, Kosice, Slovak Republic.
authors.forename: Marek
authors.initials: M
authors.lastname: Soltes
authors.affiliation: 1 Department of Surgery, University of Pavol Jozef Safarik, Kosice, Slovak Republic.
authors.forename: Jozef
authors.initials: J
authors.lastname: Radoňak
keywords: cholecystectomy; conversion; laparoscopic surgery; natural orifice translumenal endoscopic surgery; one-day surgery; single incision laparoscopic surgery