Parkland Grading Scale: Predictive Accuracy for Outcome Prediction in Gallbladder Surgery

Background: Laparoscopic Cholecystectomy (LC) has become the preferred approach for treating symptomatic gallstone disease. Numerous preoperative cholecystitis grading systems have been created to predict both intraoperative and postoperative outcomes; however, only a few of these systems address anatomical variations encountered during surgery. Furthermore, aside from identifying challenging cases, few of these grading scales have been utilized for comparing postoperative complications. To address these limitations, the Parkland Grading Scale for Cholecystitis (PGS) was developed to assess the severity of gallbladder (GB) disease. This study aims to prospectively validate the PGS as a tool for predicting LC outcomes. Materials and Methods: The study involved 156 patients undergoing laparoscopic cholecystectomy. The initial grade was determined solely based on the objective criteria outlined in the PGS and was assigned immediately after the initial view was observed. 5 independent surgeon raters, who were not involved in the original study, retrospectively reviewed the stored images from the study period. The cases were randomly assigned in equal numbers to each rater, who then evaluated the images using the PGS. Results: The average age of the patients in this study was 47.56 ± 17.54 years. The association between complications and PGS grades was not statistically significant. The majority of patients (67.31%) were classified under Grade 1, indicating relatively easier procedures. Grade 2 followed at 17.31%, reflecting moderate complexity. Grades 3, 4, and 5, indicating increasing levels of surgical difficulty, had lower frequencies, with Grade 3 at 7.69%, and Grades 4 and 5 at 3.85% each. The mean surgical difficulty scores were 1.25 ± 0.34 for PGS Grade 1, 1.80 ± 0.77 for PGS Grade 2, 3.38 ± 0.69 for PGS Grade 3, 4.75 ± 0.74 for PGS Grade 4, and 5 ± 0.00 for PGS Grade 5. Conclusion: The Parkland Grading Scale is a reliable tool for assessing the difficulty of laparoscopic cholecystectomy and predicting both intraoperative and postoperative complications. This scale provides a practical method for evaluating gallbladder diseases, which can assist in predicting LC outcomes, guiding case allocation based on surgical difficulty, and determining the need for conversion to open surgery.