Ozan Barış NAMDAROĞLU, Ferhat DEMİRCİ, Fatma DİKİŞER, Beyza GÜMÜŞTEKİN
Forbes Tıp Dergisi - 2026;7(1):15-22
Objective: To identify factors associated with difficult laparoscopic cholecystectomy (DLC) in patients aged 65 years and older and to evaluate the predictive value of inflammatory markers. Methods: This single-center retrospective cohort study included patients aged 65 years and older who underwent laparoscopic cholecystectomy between 2015 and 2025. Difficult surgery was defined as conversion to open surgery and/or subtotal (bail-out) cholecystectomy and/or operative time of 120 minutes or longer. The C-reactive protein-to-albumin (CAR) ratio was calculated as C-reactive protein (CRP) divided by albumin. Multivariable logistic regression was used to identify independent predictors. Results: A total of 726 patients were analyzed; the median age was 70 years (25th-75th percentile, 67-74), and 35.7% were male. Surgical difficulty occurred in 276 patients (38.0%). Conversion to open surgery occurred in 95 patients (13.1%) and was most commonly due to unsafe or uncertain anatomy (89.5% of conversions). The difficult group had a longer hospital stay (median 4 days compared with 1 day), a greater need for intensive care (34.8% compared with 8.4%), and a higher 30-day mortality (2.9% compared with 0.4%). Independent predictors were: acute cholecystitis [adjusted odds ratio (aOR) 8.79; 95% confidence interval (CI): 2.00-38.73]; a higher log-transformed CAR ratio (aOR): 1.45; 95% CI: 1.29-1.63); and male sex aOR: 1.44; 95% CI: 1.02-2.03). Conclusion: In older adults, DLC are common and associated with worse perioperative outcomes. The CAR ratio may support preoperative risk stratification and operative planning in this population.
