Preoperative CRP Predicts Surgical Complexity in acute calculous cholecystitis: Study

A new study published in the BMC Surgery revealed that elevated preoperative C-reactive protein (CRP) levels are significantly associated with greater surgical complexity and a higher risk of conversion in acute calculous cholecystitis (ACC). CRP can therefore serve as a useful predictor for anticipating technical challenges and improving surgical planning and resource utilization, particularly in resource-limited settings.

Acute calculous cholecystitis (ACC) is one of the most common surgical emergencies globally where the standard treatment is Laparoscopic Cholecystectomy. However, in complicated cases surgeons may need to switch to the more invasive Open Cholecystectomy, which can prolong surgery and recovery. Thus, this observational study at Shree Birendra Hospital in Kathmandu, Nepal, examined whether preoperative levels of CRP could predict surgical complexity in ACC cases.

The study from April 2024 to March 2025, included 108 patients who underwent emergency laparoscopic gallbladder removal. Patients with other medical conditions known to influence CRP levels were excluded to ensure accurate results. This research defined a “difficult” laparoscopic procedure as one lasting longer than 60 minutes.

The results showed a clear relationship between elevated CRP levels and surgical difficulty. Of the 108 patients studied, 71 underwent straightforward laparoscopic procedures, 28 experienced difficult operations, and 9 required conversion to open surgery.

Patients who had uncomplicated procedures had a mean CRP level of 18.2 mg/L. In comparison, those who experienced difficult laparoscopic surgeries had an average CRP level of 36 mg/L. The highest levels were observed in patients whose surgeries were converted to open procedures, averaging 50.1 mg/L.

Statistical analysis confirmed a significant association between high CRP levels and surgical complexity. The findings also revealed that both the duration of surgery and the length of hospital stay increased as the complexity of the operation rose.

Also, demographic factors like age and gender did not show any significant link with surgical difficulty. The study population had a mean age of 49.8 years and a male-to-female ratio of approximately 1:3.5, which reflected higher prevalence of gallbladder disease among women.

The research suggest that these findings could have practical implications for surgical teams, particularly in hospitals with limited resources. Overall, the study points that CRP testing is inexpensive and widely available, and it could serve as a useful preoperative indicator for anticipating technical challenges.

Source:

Rayamajhi, B. B., Shrivastav, A., Karki, G., Ayer, D. B., & Pradhan, S. K. (2026). C-reactive protein as a predicting factor for difficult laparoscopic cholecystectomy or its conversion to open cholecystectomy in acute calculous cholecystitis: an observational study. BMC Surgery. https://doi.org/10.1186/s12893-026-03650-4