Establishment and Application of a Grading Management Model for Laparoscopic Cholecystectomy.

BACKGROUND Laparoscopic cholecystectomy (LC) has become the preferred surgical method for treating various benign gallbladder diseases. Despite extensive research domestically and internationally on the identification of risk factors associated with LC, there remains a significant deficiency in the development of efficient and practical grading management models for LC surgery, particularly concerning the surgical experience of surgeons. MATERIAL AND METHODS A retrospective study was conducted across 2 hospitals in Shanghai from June 2013 to June 2018. Retrospective analysis using chi-square tests was performed to identify factors influencing the conversion to open surgery and the incidence of complications following LC. Thereafter, logistic regression analysis was performed using the likelihood ratio test based on the maximum partial likelihood estimates, to ascertain these risk factors. Simultaneously, using the scoring system, a hierarchical management model for LC procedures was developed and subsequently validated through a prospective cohort study. RESULTS The receiver operating characteristic curve was constructed, yielding an area under the curve of 0.893 (95% confidence interval: 0.871 to 0.914). An evaluation score exceeding 3 indicated a higher risk associated with LC surgery. Clinical validation demonstrated that this scoring system, in conjunction with a stratified management approach, can effectively reduce the open conversion rate and minimize surgical complications for LC procedures. CONCLUSIONS This study is the first to combine the experience of surgeons for LC surgery grading management, and demonstrates the reliability and effectiveness of the scoring system and hierarchical management method, reducing the conversion rate and surgical complications of LC surgery.