Surgery · 1 h ago
CRP may help identify patients who benefit most from ICG during emergency cholecystectomy
A prospective cohort study of 221 patients undergoing emergency laparoscopic cholecystectomy examined whether preoperative CRP levels modified outcomes associated with indocyanine green (ICG) fluorescence cholangiography. The association with shorter operative time varied by CRP level, while conversion findings were hypothesis-generating and the formal interaction test was not significant.
- Prospective cohort included 221 emergency cholecystectomy patients.
- Conversion occurred in 8.8% without ICG and none with ICG.
- CRP-by-ICG interaction was significant for operative time.
- Conversion interaction was not significant; findings are hypothesis-generating.
Indocyanine green fluorescence cholangiography can add cost to emergency cholecystectomy, and evidence for reducing conversion to open surgery or operative time remains limited. In this prospective cohort, 221 patients with acute cholecystitis underwent emergency laparoscopic cholecystectomy: 85 with ICG and 136 with conventional surgery. Researchers assessed whether preoperative C-reactive protein (CRP) modified the association between ICG use and conversion, operative time, length of stay, or complications.
Conversion occurred in 12 patients in the conventional group (8.8%) and none in the ICG group. Across rising CRP tertiles, conversion in the conventional group increased from 0% to 15.4%. However, the CRP-by-ICG interaction for conversion was not significant (p=0.878). Estimated absolute risk reductions were 9.8 percentage points in the middle CRP tertile and 15.4 points in the highest. The interaction was significant for operative time (p=0.045), with a stronger result in a log-CRP sensitivity analysis (p=0.001); CRP-related increases in operative time were smaller in the ICG group.
These observational results suggest that ICG’s association with operative time may differ by CRP level, but do not establish a CRP-based strategy for selecting patients. The conversion pattern is uncertain, and prospective testing is needed before using CRP to prioritize ICG.
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Surgical Endoscopy: Targeting indocyanine green where it matters most: a CRP-stratified cohort study in acute cholecystitis ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.