Preoperative and perioperative predictors of prolonged hospital stay after uncomplicated elective laparoscopic cholecystectomy: a retrospective cohort study

BACKGROUND: Although laparoscopic cholecystectomy is considered the gold standard for benign gallbladder disease and is typically associated with short hospitalization, a subset of patients experience prolonged length of stay (LOS), increasing healthcare costs and resource utilization. Early identification of patients at risk for extended hospitalization may facilitate perioperative optimization and discharge planning. This study aimed to identify perioperative predictors of prolonged hospital stay following uncomplicated elective laparoscopic cholecystectomy and to evaluate the discriminative performance of a multivariable predictive model. METHODS: In this single-center retrospective cohort study, 718 adult patients who underwent uncomplicated elective laparoscopic cholecystectomy between January 2024 and August 2025 were analyzed. Patients with conversion to open surgery, reoperation, or major postoperative complications were excluded from the primary analysis and evaluated separately as an Extended Cohort (n = 31). Prolonged hospital stay was defined as LOS > 2 days. Preoperative variables included demographic characteristics, ASA score, preoperative imaging findings, and prior biliary interventions, while operative duration and surgeon experience were assessed as intraoperative variables. Variables with p < 0.10 in univariate analysis were entered into a multivariable logistic regression model. Model discrimination was assessed using receiver operating characteristic (ROC) curve analysis. RESULTS: Of the 718 patients, 263 (36.6%) experienced prolonged hospitalization. In multivariable analysis, increasing age (OR 1.02 per year, 95% CI 1.00-1.03, p = 0.009), higher ASA score (OR 1.28, 95% CI 1.05-1.56, p = 0.015), longer operative duration (OR 1.03 per minute, 95% CI 1.02-1.04, p < 0.001), higher preoperative imaging score (OR 1.25, 95% CI 1.09-1.43, p = 0.002), and prior ERCP (OR 2.45, 95% CI 1.24-4.84, p = 0.010) were independently associated with prolonged LOS. Surgeon experience was not significantly associated with hospital stay after adjustment. The multivariable model demonstrated good discriminative ability (AUC 0.76), outperforming operative duration alone (AUC 0.59) and the preoperative-only model (AUC 0.69). CONCLUSION: Prolonged hospital stay following uncomplicated laparoscopic cholecystectomy is primarily driven by patient characteristics and disease severity rather than surgeon experience. A structured perioperative risk model incorporating clinical, radiological, and intraoperative variables may improve discharge planning and optimize hospital resource utilization. The proposed model applies to uncomplicated elective procedures, whereas complication-related hospitalization represents a distinct clinical entity requiring separate predictive frameworks. Prospective multicenter validation is warranted.