Clinical value of C-reactive protein as a predictor of conversion of laparoscopic cholecystectomy to open surgery: a systematic review and meta-analysis.
5 affiliations
- 1South Tees NHS Hospitals Trust, Middlesbrough, UK.
- 2Imperial College Healthcare NHS Trust, London, UK.
- 3Warrington & Halton NHS Foundation Trust, Warrington, UK.
- 4South Valley University, Qena, Egypt.
- 5University of Khartoum, Alqasr Avenue, P.O. Box 102, Khartoum, Sudan. [email protected].
Abstract
Background
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.Methods
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.Results
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).Conclusion
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.
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BibTeX
@article{abuali2026clinical,
title = {{Clinical value of C-reactive protein as a predictor of conversion of laparoscopic cholecystectomy to open surgery: a systematic review and meta-analysis.}},
author = {Hassan Abuali and Mohamed Mudawi and Ibrahim Fagiri and Osman S Elhassan and Abdalla O Abdalla and Ahmed Fikry Mohamed and Sagad O O Mohamed},
journal = {BMC gastroenterology},
year = {2026},
month = jul,
doi = {10.1186/s12876-026-05167-9},
url = {https://europepmc.org/article/MED/42897457},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Clinical value of C-reactive protein as a predictor of conversion of laparoscopic cholecystectomy to open surgery: a systematic review and meta-analysis.
AU - Hassan Abuali
AU - Mohamed Mudawi
AU - Ibrahim Fagiri
AU - Osman S Elhassan
AU - Abdalla O Abdalla
AU - Ahmed Fikry Mohamed
AU - Sagad O O Mohamed
PY - 2026
DA - 2026/07/01
JO - BMC gastroenterology
DO - 10.1186/s12876-026-05167-9
UR - https://europepmc.org/article/MED/42897457
AB - Background 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.Methods 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.Results 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).Conclusion 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.
SN - 1471-230X
ER -