{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T16:51:28Z","timestamp":1791910288559,"version":"4.3.4"},"reference-count":27,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2019,10,22]],"date-time":"2019-10-22T00:00:00Z","timestamp":1571702400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Early laparoscopic cholecystectomy (LC) is advocated in patients with an acute biliary presentation but may require some precaution. We aimed to assess the intra\u2010operative difficulty of cholecystectomy in patients who underwent early intervention, and to establish a prediction model for a \u2018complicated\u2019 LC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Retrospective analysis of prospectively collected data from patients presenting to the emergency department with acute biliary symptoms, and who subsequently underwent early LC between 2015 and 2018. Operative difficulty was assessed by standardized grading of intra\u2010operative findings (grades 1\u20134). Pre\u2010operative predictors for a \u2018complicated\u2019 LC (grades 3\/4) were assessed using univariable and multivariable logistic regression analysis. A prediction model was created using variable regression coefficients. Cut\u2010off and accuracy of the model were assessed using a receiver operating characteristic curve.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 185 patients were included and 59% presented with acute cholecystitis. In this cohort 113 (61%) patients underwent a \u2018complicated\u2019 LC. A prediction model for a \u2019complicated\u2019 LC (0\u20134.5 points) included: clinical diagnosis of acute cholecystitis (2 points), C\u2010reactive protein &gt;10.5\u2009mg\/L (1.5 points) and pericholecystic fluid on pre\u2010operative imaging (1 point). A score \u22652.5 had a sensitivity of 77.7%, specificity of 81.7% and positive and negative predictive values of 87.0% and 69.9%, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Early LC may be \u2018complicated\u2019 in up to 60% of cases. The presented prediction model uses readily available information in the emergency department and is a simple but accurate way to predict a likely \u2018complicated\u2019 LC in patients with acute biliary presentations.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ans.15493","type":"journal-article","created":{"date-parts":[[2019,10,23]],"date-time":"2019-10-23T03:29:17Z","timestamp":1571801357000},"page":"1451-1456","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":33,"title":["Predicting operative difficulty of laparoscopic cholecystectomy in patients with acute biliary presentations"],"prefix":"10.1111","volume":"89","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1009-1551","authenticated-orcid":false,"given":"Sarah Z.","family":"Wennmacker","sequence":"first","affiliation":[{"name":"Department of Surgery Radboud University Medical Center  Nijmegen The Netherlands"},{"name":"Department of Upper Gastrointestinal Surgery Royal North Shore Hospital  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nazim","family":"Bhimani","sequence":"additional","affiliation":[{"name":"Department of Upper Gastrointestinal Surgery Royal North Shore Hospital  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aafke H.","family":"van Dijk","sequence":"additional","affiliation":[{"name":"Department of Surgery Academic Medical Center  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas J.","family":"Hugh","sequence":"additional","affiliation":[{"name":"Department of Upper Gastrointestinal Surgery Royal North Shore Hospital  Sydney New South Wales Australia"},{"name":"Discipline of Surgery The University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip R.","family":"de Reuver","sequence":"additional","affiliation":[{"name":"Department of Surgery Radboud University Medical Center  Nijmegen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,10,22]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2009.12.020"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1155\/2010\/901739"},{"key":"e_1_2_8_4_1","first-page":"13","article-title":"Diagnostic accuracy of clinical examination, inflammatory markers, and abdominal ultrasound in differentiating biliary colic from acute cholecystitis","volume":"104","author":"Mohamed S","year":"2017","journal-title":"Br. 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