Fan Feng, Gong Tao, Xu Hongxing, Gu Qiang
Objective To identify clinical factors associated with postoperative complications after laparoscopic common bile duct exploration（LCBDE） using the Clavien-Dindo grading system, and to develop and validate a practical prediction model. Methods In this prospective study, 285 consecutive patients undergoing LCBDE at the First People's Hospital of Taicang（January 2023-May 2025） were randomly allocated 2∶1 to a training set（n=190） and a validation set（n=95）.Postoperative complications were recorded and graded by the Clavien-Dindo classification.In the training set, patients who developed Clavien-Dindo grade≥Ⅱ complications formed the even group（n=26）;the remainder constituted the complications grade 0~Ⅰ group（n=164）.Baseline characteristics, comorbidities, laboratory values, and intraoperative variables were compared. Independent predictors of grade≥Ⅱ complications were identified by multivariable logistic regression and used to construct a predictive model. Model discrimination was assessed by receiver operator characteristic（ROC） curve; calibration was evaluated with calibration plots and the Hosmer-Lemeshow test. Results Compared with complications grade 0~Ⅰ patients, those who developed grade≥Ⅱ complications had higher rates of ASA≥Ⅲ, more frequent moderate/severe acute cholangitis, higher Charlson comorbidity index（CCI） scores, and greater intraoperative blood loss; they also had lower serum albumin （all P<0.05）.Multivariable analysis showed ASA≥Ⅲ（OR=3.550, 95%CI： 1.271-9.915）, CCI（OR=2.617, 95%CI： 1.151-5.949）, moderate/severe acute cholangitis（OR=2.171, 95%CI：1.296-3.635）, and intraoperative blood loss（OR=2.872, 95%CI：1.322-6.241） were independent risk factors, while higher albumin was protective（OR=0.426, 95%CI：0.200-0.904）.The final logistic model：logit [P（complication≥Ⅱ）] = -12.874-0.854X1（albumin） + 1.267X2（ASA≥Ⅲ） +0.962X3（CCI） +0.775X4（moderate/severe cholangitis） + 1.055X5（intraoperative blood loss）.（For binary predictors, code 1 if present, 0 if absent; continuous predictors are entered as measured.） Model performance was strong： training set area under the curve（AUC）=0.929 （sensitivity 84.62%, specificity 98.17%）; validation set AUC= 0.920 （sensitivity 92.31%, specificity 81.71%）.Hosmer-Lemeshow tests showed good calibration in both sets （training χ2=6.036, P=0.702;validation χ2=7.254, P=0.512）. Conclusion Higher ASA class（≥Ⅲ）, greater comorbidity burden（CCI）, concomitant moderate/severe acute cholangitis, and larger intraoperative blood loss increase the risk of postoperative Clavien-Dindo grade≥Ⅱ complications after LCBDE;higher serum albumin is protective.The internally validated prediction model demonstrates excellent discrimination and calibration and may help identify high-risk patients who would benefit from intensified postoperative management.
