How to Predict Postoperative Complications After Early Laparoscopic Cholecystectomy for Acute Cholecystitis: the Chole-Risk Score

Marcello Di Martino*, Ismael Mora-Guzmán, Víctor Vaello Jodra, Alfonso Sanjuanbenito Dehesa, Dieter Morales García, Rubén Caiña Ruiz, Francisca García Moreno Nisa, Fernando Mendoza Moreno, Sara Alonso Batanero, José Edecio Quiñones Sampedro, Paola Lora Cumplido, Altea Arango Bravo, Ines Rubio-Perez, Luis Asensio-Gomez, Fernando Pardo Aranda, Sara Sentí Farrarons, Cristina Ruiz Moreno, Clara Maria Martinez Moreno, Aingeru Sarriugarte Lasarte, Mikel Prieto CalvoDaniel Aparicio-Sánchez, Eduardo Perea Del Pozo, Gianluca Pellino, Elena Martin-Perez

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

4 Citations (Scopus)


Background: Early laparoscopic cholecystectomy (ELC) is the gold standard treatment for patients with acute calculous cholecystitis (ACC); however, it is still related to significant postoperative complications. The aim of this study is to identify factors associated with an increased risk of postoperative complications and develop a preoperative score able to predict them. Methods: Multicentric retrospective analysis of 1868 patients with ACC submitted to ELC. Included patients were divided into two groups according to the presentation of increased postoperative complications defined as postoperative complications ≥ Clavien-Dindo IIIa, length of stay greater than 10 days and readmissions within 30 days of discharge. Variables that were independently predictive of increased postoperative complications were combined determining the Chole-Risk Score, which was validated through a correlation analysis. Results: We included 282 (15.1%) patients with postoperative complications. The multivariate analysis predictors of increased morbidity were previous percutaneous cholecystostomy (OR 2.95, p=0.001), previous abdominal surgery (OR 1.57, p=0.031) and diabetes (OR 1.62, p=0.005); Charlson Comorbidity Index >6 (OR 2.48, p=0.003), increased total bilirubin > 2 mg/dL (OR 1.88, p=0.002), dilated bile duct (OR 1.79, p=0.027), perforated gallbladder (OR 2.62, p<0.001) and severity grade (OR 1.93, p=0.001). The Chole-Risk Score was generated by grouping these variables into four categories, with scores ranging from 0 to 4. It presented a progressive increase in postoperative complications ranging from 5.8% of patients scoring 0 to 47.8% of patients scoring 4 (p<0.001). Conclusion: The Chole-Risk Score represents an intuitive tool capable of predicting postoperative complications in patients with ACC.

Original languageEnglish
Pages (from-to)2814-2822
Number of pages9
JournalJournal of Gastrointestinal Surgery
Issue number11
Publication statusPublished - Nov 2021


  • cholecystectomy
  • cholecystitis
  • early laparoscopic cholecystectomy
  • postoperative complication


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