TPT 8.15 A Simple End-Of-Operation Risk Score for Clavien–Dindo Grade III–V Complications after Intended Laparoscopic Cholecystectomy: A Multicentre NHS Cohort Study

Abstract

Major complications after laparoscopic cholecystectomy (LC) are uncommon but drive morbidity and resource use. We developed a pragmatic risk score using routinely available variables to support end-of-case escalation and postoperative planning. Retrospective multicentre cohort of consecutive cholecystectomies across three acute hospitals (NHS Lanarkshire; 4 Jan 2023–3 Nov 2024). Patients with intended LC (including conversions) were included. Outcome was Clavien–Dindo (CD) III–V within 30 days. Prespecified predictors were modelled with parsimonious logistic regression with bootstrap internal validation; coefficients were converted to an integer score. A restricted pre-operative “consent” model was also assessed. Of 794 cholecystectomies, 780 (98.2%) were intended LC. CD III–V occurred in 44/780 (5.6%), including one death (0.1%). End-of-operation predictors were SIMD deciles 1–2, subtotal/abandoned cholecystectomy, and subhepatic drain placement (AUC 0.70). The integer score (SIMD 1–2=1; subtotal/abandoned=2; drain=3; range 0–6) stratified observed risk from 3.1% (0–1) to 29.6% (6). A restricted pre-operative model (ASA ≥3, acute inflammatory presentation, non-elective surgery, CBD stones, SIMD 1–2) showed lower discrimination (AUC 0.65). Decision-curve analysis demonstrated net benefit for the peri-operative model across thresholds ∼3–25% and for the pre-operative model across ∼4–20%. A simple end-of-case score using deprivation and two intra-operative escalation signals identifies patients at higher risk of major (CD III–V) complications after LC. It may support targeted surveillance, audit, and quality improvement; external validation with robust 30-day outcome linkage is required.