title: A preoperative predictive scoring system to predict the ability to achieve the critical view of safety during laparoscopic cholecystectomy for acute cholecystitis.
abstract: The aim of this study was to develop a preoperative scoring system to predict the ability to achieve the critical view of safety (CVS) in patients undergoing emergency laparoscopic cholecystectomy (LC) for acute cholecystitis (AC).
  
  
  
  A retrospective review of patients who underwent LC for AC between 2012 and 2015 was performed. The achievement or failure of creating the CVS was judged by operative records, video recordings, and interviews of the surgeons. Independent preoperative variables associated with failure were determined by multivariate logistic regression analysis and a prediction scoring system created.
  
  
  
  A C-reactive protein (CRP) >5.5 mg/dl, gallstone impaction, and symptom onset to operation >72 h were identified as independently correlated risk factors for the failure to achieve the CVS. A preoperative risk scoring system for the failure to create the CVS (0-5 points) was constructed using these 3 factors: CRP >5.5 mg/dl (2 points), gallstone impaction (1 points), and time from symptom onset to operation >72 h (2 points). When monitoring the frequency of patients who had a failure to create the CVS at each score, the incidence of failure increased as the score increased (P<0.001).
  
  
  
  Using only three preoperative factors, the proposed scoring system provides an objective evaluation of the likelihood that CVS can be achieved in patients undergoing emergency LC for AC.
authors.affiliation: Department of Surgery, Ogaki Municipal Hospital, Gifu, Japan. Electronic address: sonoe@med.nagoya-u.ac.jp.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Onoe
authors.affiliation: Department of Surgery, Ogaki Municipal Hospital, Gifu, Japan.
authors.forename: Atsuyuki
authors.initials: A
authors.lastname: Maeda
authors.affiliation: Department of Surgery, Ogaki Municipal Hospital, Gifu, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Takayama
authors.affiliation: Department of Surgery, Ogaki Municipal Hospital, Gifu, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Fukami
authors.affiliation: Department of Surgery, Ogaki Municipal Hospital, Gifu, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kaneoka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D016009:Chi-Square Distribution; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects; D041881:Cholecystitis, Acute / Q000097:blood / Q000175:diagnosis / Q000601:surgery*; D003661:Decision Support Techniques; D004630:Emergencies; D005260:Female; D042882:Gallstones / Q000097:blood / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein