Lee Huisong, Han In Woong, Choi Ji Eun, Lee Hyeon Kook
Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea.
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Ann Surg Treat Res. 2025 Jun;108(6):352-361. doi: 10.4174/astr.2025.108.6.352. Epub 2025 Jun 2.
Laparoscopic cholecystectomy is the standard surgical procedure for benign gallbladder disease. However, the analysis of risk factors for complications, including serious complications such as bile duct injury (BDI), has been largely overlooked. This study aimed to collect standardized prospective data from multiple centers and to develop a predictive model for laparoscopic cholecystectomy complications.
This study included 2,514 patients who underwent laparoscopic cholecystectomy for benign gallbladder disease at 18 academic institutes in Korea. Fifty-six preoperative and intraoperative variables were analyzed as risk factors for adverse postoperative outcomes, including overall complications. A surgical risk calculator was developed using a multivariate logistic regression analysis.
Of the 2,514 patients, 62 (2.5%) experienced surgery-related complications, including BDI in 17 (0.7%). Various factors such as sex, age, smoking, emergency operation, hypertension, diabetes mellitus, chronic obstructive pulmonary disease, preoperative endoscopic common bile duct stone removal, therapeutic antibiotics usage, American Society of Anesthesiologists physical status classification, and acute cholecystitis were found to be associated with postoperative adverse outcomes. Based on these variables, a surgical risk calculator was developed for overall complications, systemic complications, surgery-related complications, BDI, and delayed discharge, with the area under the curve values of 0.733, 0.775, 0.697, 0.857, and 0.833, respectively.
This study developed a surgical risk calculator using standardized variables from a multi-institutional prospective database to predict adverse outcomes after laparoscopic cholecystectomy. This tool can be used for risk stratification prior to cholecystectomy.
腹腔镜胆囊切除术是治疗良性胆囊疾病的标准外科手术。然而，对包括胆管损伤（BDI）等严重并发症在内的并发症危险因素的分析在很大程度上被忽视了。本研究旨在从多个中心收集标准化的前瞻性数据，并建立腹腔镜胆囊切除术并发症的预测模型。
本研究纳入了韩国18家学术机构中因良性胆囊疾病接受腹腔镜胆囊切除术的2514例患者。分析了56个术前和术中变量作为术后不良结局（包括总体并发症）的危险因素。使用多因素逻辑回归分析开发了一个手术风险计算器。
在2514例患者中，62例（2.5%）出现了与手术相关的并发症，其中17例（0.7%）发生了胆管损伤。发现性别、年龄、吸烟、急诊手术、高血压、糖尿病、慢性阻塞性肺疾病、术前内镜下胆总管结石取出术、治疗性抗生素使用、美国麻醉医师协会身体状况分级以及急性胆囊炎等多种因素与术后不良结局相关。基于这些变量，开发了一个手术风险计算器，用于预测总体并发症、全身并发症、手术相关并发症、胆管损伤和延迟出院，其曲线下面积值分别为0.733、0.775、0.697、0.857和0.833。
本研究使用来自多机构前瞻性数据库的标准化变量开发了一个手术风险计算器，以预测腹腔镜胆囊切除术后的不良结局。该工具可用于胆囊切除术前的风险分层。
