Preoperative prediction model of outcome after cholecystectomy for symptomatic gallstones

Background: After cholecystectomy for symptomatic gallstone disease 20%-30% of the patients continue to have abdominal pain. The aim of this study was to investigate whether preoperative variables could predict the symptomati c outcome after cholecystectomy. Methods: One hundred and two patients were referred to elective cholecystectomy in a prospective study. Median age wa s 45 years; range, 20-81 years. A preoperative questionnaire on pain, sympt oms, and history was completed, and the questions on pain and symptoms were repeated I year postoperatively. Preoperative cholescintigraphy and sonogr aphy evaluated gallbladder motility, gallstones, and gallbladder volume. Pr eoperative variables in patients with or without postcholecystectomy pain w ere compared statistically, and significant variables were combined in a lo gistic regression model to predict the postoperative outcome. Results: Eigh ty patients completed all questionnaires. Twenty-one patients continued to have abdominal pain after the operation. Patients with pain 1 year after ch olecystectomy were characterized by the preoperative presence of a high dys pepsia score,'irritating' abdominal pain, and an introverted personality an d by the absence of 'agonizing' pain and of symptoms coinciding with pain ( P < 0.000001). In a constructed logistic regression model 15 of 18 predicte d patients had postoperative pain (PVpos = 0.83). Of 62 patients predicted as having no pain postoperatively, 56 were pain-free (PVneg = 0.90). Overal l accuracy was 89%. Conclusion: From this prospective study a model based o n preoperative symptoms was developed to predict postcholecystectomy pain. Since intrastudy reclassification may give too optimistic results, the mode l should be validated in future studies.