- Design
- Prospective cohort, CRP-stratified
- Population
- 221 emergency laparoscopic cholecystectomies for acute cholecystitis (85 ICG)
- Primary outcome
- Conversion to open surgery
- Effect
- 0/85 vs 12/136 (8.8%); ARR 15.4 points (95% CI 8.0 to 27.5) in top CRP tertile
A prospective cohort of 221 emergency laparoscopic cholecystectomies for acute cholecystitis compared 85 operations with indocyanine green fluorescence cholangiography against 136 without, asking whether preoperative CRP identifies who benefits most.
All 12 conversions (8.8%) were in the conventional group; none occurred with ICG. Conversion without ICG rose from 0% in the lowest CRP tertile to 15.4% in the highest, giving an estimated absolute reduction of 9.8 points in the middle tertile (number needed to treat about 10) and 15.4 points in the top tertile (about 6.5). The formal interaction test for conversion was not significant, largely because there were no ICG events, but the CRP-related lengthening of operating time was clearly smaller with ICG.
This is not randomised, and choice of ICG may have tracked surgeon or case factors. It is a reasonable basis for prioritising ICG where supply or cost is limited, and for a trial.
- No conversions occurred with ICG cholangiography against 8.8% without in this non-randomised cohort.
- The benefit appeared concentrated in patients with higher preoperative CRP.
- Where ICG is limited, consider prioritising it for cholecystitis with high CRP.
- ICG supplements, and does not replace, achieving the critical view of safety.
Why it matters
Targeting a costly adjunct to the hardest cases may get most of its benefit at a fraction of the cost.
Don't overread it
The CRP interaction for conversion was not statistically significant and the groups were not randomised.
The statistics, in plain English
A number needed to treat of about 6.5 in the top CRP tertile means ICG in roughly every six or seven such operations was associated with one fewer conversion. Wide confidence intervals reflect the small number of events.
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