Biochemical and Hematological Markers for Predicting Difficult Laparoscopic Cholecystectomy in Patients Aged ≥65 Years: A Retrospective Cohort Study

Introduction: To dent fy factors assoc ated w th d ff cult laparoscop c cholecystectomy n pat ents aged 65 years and older and to evaluate the pred ct ve value of nflammatory markers.Material and Method: Th s s ngle-center retrospect ve cohort study ncluded pat ents aged 65 years and older who underwent laparoscop c cholecystectomy between 2015 and 2025.D ff cult surgery was def ned as convers on to open surgery and/or subtotal (ba l-out) cholecystectomy and/or operat ve t me of 120 m nutes or longer.The C-react ve prote n-to-album n rat o was calculated as C-react ve prote n d v ded by album n.Mult var able log st c regress on was used to dent fy ndependent pred ctors.Results: A total of 726 pat ents were analyzed; the med an age was 70 years (25th-75th percent le, 67-74), and 35.7% were male.D ff cult surgerySurg cal d ff culty occurred n 276 pat ents (38.0%).Convers on to open surgery occurred n 95 pat ents (13.1%) and was most commonly due to unsafe or uncerta n anatomy (89.5% of convers ons).The d ff cult group had a longer hosp tal stay (med an 4 days compared w th 1 day), a greater need for ntens ve care (34.8% compared w th 8.4%), and a h gher 30-day mortal ty (2.9% compared w th 0.4%).Independent pred ctors were: acute cholecyst t s (adjusted odds rat o 8.79; 95% conf dence nterval 2.00-38.73),;a h gher log-transformed C-react ve prote n-to-album n rat o (adjusted odds rat o 1.45; 95% conf dence nterval 1.29-1.63),;and male sex (adjusted odds rat o 1.44; 95% conf dence nterval 1.02-2.03).Conclus on: In older adults, d ff cult laparoscop c cholecystectomycholecystectom es sare common and s assoc ated w th worse per operat ve outcomes.The C-react ve prote n-to-album n rat o may support preoperat ve r sk strat f cat on and operat ve plann ng n th s populat on.