Association of high sensitivity C - reactive protein with intraoperative difficulty score in laparoscopic cholecystectomy.

Introduction: C reactive protein has been shown to correlate with the severity of inflammation. Since the operative difficulty during laparoscopic cholecystectomy is proportionate to the degree of inflammation, this study was carried out to assess the predictive accuracy of high sensitivity C reactive protein (hs-CRP) level with the operative difficulty and outcome. Methods: This was a prospective study, which included patients who underwent elective laparoscopic cholecystectomy. Difficulty during surgery was graded into mild, moderate, severe, and extreme based upon intra-operative parameters. The association of intraoperative difficulty grading with hs-CRP, total leucocyte count, liver function test, and ultrasonographic findings were studied Results: A total of 103 patients were included in the study. 87 patients were found to have mild to moderate difficulty intraoperatively and 16 were found to have severe to extreme difficulty. Association of hs-CRP with operative difficulty was found to have an adjusted odds ratio of 1.25(1.04, 1.51) with a p-value of 0.009. For a cut-off of 9.63, the sensitivity and specificity of hs-CRP were 62.5% and 62.1%. The positive predictive value and the negative predictive value were 23.25% and 90% respectively. For the calculated cut-off, the accuracy of hs-CRP was 62.13% while overall accuracy for hs-CRP was seen to be 70.5% with a confidence interval of 0.553-0.858. Conclusion: The study shows that the preoperatively measured hs-CRP has moderate sensitivity and specificity for predicting the operative difficulty in elective laparoscopic cholecystectomy. The previous history of acute cholecystitis was also found to be an independent predictor of operative difficulty. [ABSTRACT FROM AUTHOR]