Abstract
Background
Laparoscopic cholecystectomy operative difficulty is highly variable and influences
outcomes. This systematic review analyzes the performance and clinical value of statistical
models to preoperatively predict laparoscopic cholecystectomy operative difficulty.
Methods
PRISMA guidelines were followed. PubMed, Embase, and the Cochrane Library were searched
until June 2020. Primary studies developing or validating preoperative models predicting
laparoscopic cholecystectomy operative difficulty in cohorts of >100 patients were
included. Studies not reporting performance metrics or enough information for clinical
implementation were excluded. Data were extracted according to CHARMS, and study quality
was assessed using the PROBAST tool.
Results
In total, 2,654 articles were identified, and 22 met eligibility criteria. Eighteen
were model development, whereas 4 were validation studies. Eighteen studies were at
high risk of bias. However, 11 studies showed low concern for applicability. Identified
models predict 9 definitions of laparoscopic cholecystectomy operative difficulty,
the most common being conversion to open surgery and operating time. The most validated
models predict an intraoperative difficulty scale and procedures >90 minutes with
an area under the curve of >0.70 and >0.76, respectively. Commonly used predictors
include demographic variables such as age and gender (9/18 models) and ultrasound
findings such as gallbladder wall thickness (11/18). Clinical implementation was never
studied.
Conclusion
There is a longstanding interest in estimating laparoscopic cholecystectomy operative
difficulty. Models to preoperatively predict laparoscopic cholecystectomy operative
difficulty have generally good performance and seem applicable. However, an unambiguous
definition of operative difficulty, validations, and clinical studies are needed to
implement patients’ stratification in laparoscopic cholecystectomy.
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Article info
Publication history
Published online: November 11, 2021
Accepted:
October 3,
2021
Footnotes
Maria Vannucci and Giovanni Guglielmo Laracca contributed equally and share first co-authorship.
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
