Clinical value of C-reactive protein as a predictor of conversion of laparoscopic cholecystectomy to open surgery: a systematic review and meta-analysis

Abstract

Laparoscopic cholecystectomy is the gold standard for gallbladder disease, yet conversion to open surgery remains a challenge. Unplanned conversion from laparoscopic cholecystectomy to open surgery is associated with increased morbidity and potential patient safety risks. Accurate preoperative predictors may improve surgical planning and enhance patient safety. This meta-analysis evaluates the utility of preoperative C-reactive protein (CRP) as an objective biomarker for risk stratification. A systematic review was conducted according to PRISMA guidelines. The search was performed in PubMed, Web of Science, and Scopus. We included studies reporting preoperative CRP in converted vs. non-converted laparoscopic cholecystectomy cases. Pooled standardized mean differences (SMD) and odds ratios (OR) were calculated using random-effects meta-analysis models using R version 4.3.3. Eleven studies were included. The primary SMD analysis comprised 11 studies and a secondary analysis included 5 studies reporting per-unit OR. Patients requiring conversion had significantly higher preoperative CRP levels (SMD = 1.09, 95% CI: 0.77–1.41, p < 0.001). Each one-unit increase in CRP was significantly associated with a higher conversion risk (OR: 1.012; 95% CI 1.005–1.018; p = 0.004); the equivalent OR per 10 mg/L was 1.127 (95% CI: 1.051–1.209). This meta-analysis demonstrated an association between elevated preoperative CRP and increased risk of conversion from laparoscopic to open cholecystectomy. CRP measurement may aid preoperative risk stratification when interpreted alongside clinical context.