RELATIONSHIP BETWEEN MODIFIED NASSAR INTRAOPERATIVE DIFFICULTY GRADE AND EARLY POSTOPERATIVE RECOVERY FOLLOWING LAPAROSCOPIC CHOLECYSTECTOMY

Abstract

Objective: To determine the relationship between the Modified Nassar intraoperative difficulty grade and early postoperative recovery (postoperative pain score, time to first oral intake, time to first ambulation, and length of hospital stay) in patients undergoing laparoscopic cholecystectomy. Study Design: Cross-sectional, analytical (comparative) study. Settings: Department of General Surgery, Jinnah Postgraduate Medical Centre (JPMC), Karachi. Period: November 2025 to February 2026 (four months). Material & Methods: Sixty-four patients undergoing elective laparoscopic cholecystectomy were enrolled through non-probability purposive sampling and classified intraoperatively as Group A (Modified Nassar Grade I-II, "easy", n=32) or Group B (Grade III-V, "difficult", n=32). Postoperative pain (Visual Analogue Scale, 0-10) at 6, 12 and 24 hours, time to first tolerated oral intake, time to first unassisted ambulation, and total postoperative hospital stay were recorded. Quantitative variables were compared using the independent-samples t-test, qualitative variables using the chi-square test, and the ordinal Nassar grade was correlated with recovery parameters using Spearman’s rank correlation coefficient. Data were analyzed using SPSS version 26, with p≤0.05 taken as significant. Results: The two groups were comparable at baseline. Operative duration was significantly longer in Group B (69.09±14.93 vs 59.84±15.94 minutes, p=0.020). Group B had a significantly longer time to first oral intake (7.03±3.30 vs 5.37±2.32 hours, p=0.024) and postoperative hospital stay (28.42±7.44 vs 21.68±6.88 hours, p<0.001). The composite outcome of delayed early recovery occurred in 87.5% of Group B versus 43.8% of Group A (p<0.001). Nassar grade correlated significantly with postoperative stay (rho=0.492, p<0.001), time to oral intake (rho=0.323, p=0.009), and operative time (rho=0.308, p=0.013). VAS pain scores and time to ambulation were higher in Group B but did not reach statistical significance. Conclusion: A higher Modified Nassar intraoperative difficulty grade is significantly associated with delayed early postoperative recovery after laparoscopic cholecystectomy, most consistently reflected in a longer hospital stay, supporting its routine use for postoperative planning and patient counselling.