title: How to predict difficult laparoscopic cholecystectomy? Proposal for a simple preoperative scoring system.
abstract: BACKGROUND
  Few studies have used operative time as a reflection of the surgical difficulty to create a preoperative score of operative difficulty in laparoscopic cholecystectomies (DiLCs score).
  
  
  METHODS
  Patients who benefited from cholecystectomy between 2010 and 2015 were reviewed. Difficult procedures were identified using the deviations from the operative time for simple cholecystectomies. Logistic regression analyses were carried out to build risk-assessment models and derive the DiLC score.
  
  
  RESULTS
  Overall, 644 patients were identified. Multivariate analyses identified male sex, previous cholecystitis attack, fibrinogen, neutrophil, and alkaline phosphatase count to be predictive of operative difficulties. Risk-assessment model was generated with an area under the receiver-operator curve of .80. Internal validation was performed using the bootstrap method.
  
  
  CONCLUSIONS
  The DiLC score is a simple and reliable tool which could be used to improve patient counseling, optimize surgical planning, detect procedures at risk, identify patients eligible for outpatient care, and enhance resident training.
authors.affiliation: Sainte Anne Military Teaching Hospital, Department of Oncologic and Digestive Surgery, Toulon, France. Electronic address: stephane_bourgouin@hotmail.fr.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Bourgouin
authors.affiliation: Aix-Marseille University, UMR912 SESSTIM, Inserm, IRD; APHM La Timone, Department of Public Health, Marseille, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Mancini
authors.affiliation: Sainte Anne Military Teaching Hospital, Department of Oncologic and Digestive Surgery, Toulon, France.
authors.forename: Tristan
authors.initials: T
authors.lastname: Monchal
authors.affiliation: Sainte Anne Military Teaching Hospital, Department of Oncologic and Digestive Surgery, Toulon, France.
authors.forename: Ronan
authors.initials: R
authors.lastname: Calvary
authors.affiliation: Sainte Anne Military Teaching Hospital, Department of Anesthesia and Intensive Care, Toulon, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Bordes
authors.affiliation: Sainte Anne Military Teaching Hospital, Department of Oncologic and Digestive Surgery, Toulon, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Balandraud
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D019540:Area Under Curve; D002423:Cause of Death; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000379:methods; D041881:Cholecystitis, Acute / Q000175:diagnosis / Q000601:surgery*; D002769:Cholelithiasis / Q000175:diagnosis / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology / Q000503:physiopathology*; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D015996:Survival Rate
keywords: Cholecystectomy; Cholecystitis, acute; Cholecystolithiasis; Laparoscopic; Operative difficulty; Scoring system