title: Is C-reactive protein the single most useful predictor of difficult laparoscopic cholecystectomy or its conversion? A pilot study.
abstract: BACKGROUND
  Both converted and difficult laparoscopic cholecystectomies (LC) have impact on operating time and training of juniors. The aim of this study is to evaluate parameters that predict difficult LC or conversion (C), and find predictive values for different cut-off points of C-reactive protein (CRP) for conversion.
  
  
  METHODS
  A retrospective cohort study of cholecystectomies performed from January 2011 to December 2012 at NHS trust was undertaken. Association of intra-operative difficulties or conversion with the following factors was studied: Age, gender, CRP, white blood cell count (WBC), history of pancreatitis, and endoscopic retrograde cholangiopancreatography (ERCP).
  
  
  RESULTS
  Two hundred and ninety one patients were analysed (222 laparoscopic, 45 difficult LC and 24 C). Only 141 patients had a recorded CRP. Median CRP was highest for patients who were converted (286.20) compared to those who had difficult LC (67.40) or LC (7.05). Those patients who did not have preoperative CRP (8/150, 5.3%) had less chance of conversion than those who had CRP (16/141, 11.34%) (P = 0.063). Patients with CRP of ≤220 (3/91, 3.2%) had significantly less chance of conversion than those with CRP >220 (13/21, 61.9%) (P < 0.001). High preoperative CRP, WBC count and ERCP, were predictors of conversion. These factors were only marginally better than CRP alone in predicting conversion.
  
  
  CONCLUSIONS
  CRP can be a strong predictor of conversion of LC. Further validation of the results is needed.
authors.affiliation: Department of Upper GI Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, Chorley PR7 1PP, United Kingdom.
authors.forename: Kam Wa
authors.initials: KW
authors.lastname: Jessica Mok
authors.affiliation: Department of Upper GI Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, Chorley PR7 1PP, United Kingdom.
authors.forename: Yan Li
authors.initials: YL
authors.lastname: Goh
authors.affiliation: School of Health, University of Central Lancashire, Preston, PR1 2HE, United Kingdom.
authors.forename: Laura E
authors.initials: LE
authors.lastname: Howell
authors.affiliation: Department of Upper GI Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, Chorley PR7 1PP, United Kingdom.
authors.forename: Ravindra S
authors.initials: RS
authors.lastname: Date
keywords: C-reactive protein; difficult dissection; laparoscopic cholecystectomy; predicting conversion