Evaluation of inflammation indices according to the Parkland grading scale in laparoscopic cholecystectomy: can inflammation indices predict operative difficulty? A retrospective cross-sectional study

BACKGROUND: The Parkland Grading Scale (PGS) is a practical intraoperative grading system used to assess operative difficulty during laparoscopic cholecystectomy. This study aimed to investigate the relationship between PGS scores and preoperative inflammatory indices and to evaluate whether these indices were associated with operative severity and intraoperative complexity. METHODS: This retrospective cross-sectional study included 1054 patients who underwent elective laparoscopic cholecystectomy for gallstone disease between January 2018 and January 2025. Demographic characteristics, laboratory parameters, inflammatory indices, operative duration, conversion rates, and PGS scores were analyzed. Univariate and multivariate logistic regression analyses were performed to identify variables independently associated with higher PGS severity. Receiver operating characteristic (ROC) curve analysis was used to determine diagnostic performance. RESULTS: According to the PGS classification, 451 patients were classified as PGS 1, 146 as PGS 2, 213 as PGS 3, 164 as PGS 4, and 80 as PGS 5. Operative duration and conversion from laparoscopic to open cholecystectomy increased significantly with increasing PGS scores (p < 0.001). In multivariate logistic regression analysis, type 2 diabetes mellitus (T2DM), CRP/albumin ratio (CAR), neutrophil/lymphocyte ratio (NLR), and inflammatory burden index (IBI) were identified as independent predictors of higher PGS scores (all p < 0.001). ROC analysis demonstrated that IBI had the highest discriminatory performance (AUC: 0.792), followed by NLR (AUC: 0.766) and CAR (AUC: 0.764). CONCLUSIONS: Preoperative inflammatory indices, particularly IBI, NLR, and CAR, were significantly associated with higher PGS scores and increased operative difficulty in laparoscopic cholecystectomy. These markers may help identify patients with increased operative complexity and improve preoperative surgical planning.