# CholeS elective cholecystectomy duration score CholeS score Status: LIVE Price: $0.005 USDC `GET /api/calc/choles_score` HTML: https://magentlab.com/docs/choles-score Markdown: https://magentlab.com/docs/choles-score.md Not a medical device. Not a diagnosis, dose, or listing recommendation. ## What it computes Sum Bharamgoudar 2018 Table 3 points from caller-assigned age, sex, indication, BMI, CBD diameter, gallbladder wall, pre-operative CT, planned intraoperative cholangiogram, previous surgical admissions, and ASA class, and return the numeric total (max 20). Does not classify operative duration or risk bands. ## When to use When an agent has already assigned Bharamgoudar 2018 Table 3 inputs before elective laparoscopic cholecystectomy and needs the published 0-20 point total, not an operative booking, Nassar difficulty grade, or Tokyo cholecystitis/cholangitis grade. ## When not to use - Not a medical device. This is a published arithmetic total, not an operative booking, cancellation, or theatre-time allocation. - magent does not image the gallbladder, measure CBD diameter, or assign ASA class; the caller supplies Table 3 tokens and numbers. - Not Nassar operative difficulty. This tool does not grade difficulty or conversion risk. - Not Tokyo Guidelines cholecystitis or cholangitis severity. Related Tokyo tools are separate. - Bharamgoudar 2018 reports cohort percentages lasting >90 min at score 0-3 vs >8; magent returns score and max_score only and does not classify the patient as low or high duration. ## Formula ``` CholeS = age (<40 0, >=40 1.5) + sex (female 0, male 1) + indication (pancreatitis 0, colic_dyskinesia_polyp 0.5, cbd_stone 2, acalculous_cholecystitis 2.5) + bmi_kg_m2 (<25 0, 25-35 inclusive 1, >35 2) + cbd_diameter (normal 0, dilated 2) + gallbladder_wall (normal 0, thick 1.5) + pre_operative_ct (true 1.5) + planned_intraop_cholangiogram (true 3) + previous_surgical_admissions (0 0, 1-2 1, >2 2.5) + asa_class (1 0, 2 1, 3-5 2.5); Bharamgoudar 2018 Table 3; max 20; numeric total only, no duration or risk bands ``` ## Citation [The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy](https://doi.org/10.1007/s00464-018-6030-6) Bharamgoudar R, Sonsale A, Hodson J, Griffiths E; CholeS Study Group, West Midlands Research Collaborative Surg Endosc. 2018;32(7):3149-3157 DOI: [10.1007/s00464-018-6030-6](https://doi.org/10.1007/s00464-018-6030-6) ## Worked example ### All Table 3 zeros (age 35 female pancreatitis BMI 24) Given: `age=35, asa_class=1, bmi_kg_m2=24, cbd_diameter=normal, gallbladder_wall=normal, indication=pancreatitis, planned_intraop_cholangiogram=false, pre_operative_ct=false, previous_surgical_admissions=0, sex=female` 1. Age 35 → 0; female → 0; pancreatitis → 0; BMI 24 → 0 2. CBD normal → 0; wall normal → 0; CT false → 0; IOC false → 0; admissions 0 → 0; ASA 1 → 0 3. Score = 0 (max 20). No duration band. ### All Table 3 maxima (score 20) Given: `age=40, asa_class=3, bmi_kg_m2=36, cbd_diameter=dilated, gallbladder_wall=thick, indication=acalculous_cholecystitis, planned_intraop_cholangiogram=true, pre_operative_ct=true, previous_surgical_admissions=3, sex=male` 1. Age 40 → 1.5; male → 1; acalculous_cholecystitis → 2.5; BMI 36 → 2 2. CBD dilated → 2; wall thick → 1.5; CT true → 1.5; IOC true → 3; admissions 3 → 2.5; ASA 3 → 2.5 3. Score = 20 (max 20). No duration band. ## Also searched as - CholeS score - laparoscopic cholecystectomy duration - Bharamgoudar 2018 - CholeS Study Group score - elective cholecystectomy duration score - gallbladder surgery duration points - CholeS Table 3 - LC duration score - intraoperative cholangiogram score ## Parameters - `age` (integer, required): Age in years (integer 18-120). Bharamgoudar 2018 Table 3: <40 scores 0; ≥40 scores 1.5. Age 39 scores 0; 40 scores 1.5. - `sex` (string, required): female or male. Female scores 0; male scores 1 (Bharamgoudar 2018 Table 3). - `indication` (string, required): Caller-assigned indication for elective laparoscopic cholecystectomy (Bharamgoudar 2018 Table 3). pancreatitis scores 0. colic_dyskinesia_polyp (biliary colic, biliary dyskinesia, or gallbladder polyp) scores 0.5. cbd_stone scores 2. acalculous_cholecystitis scores 2.5. magent does not diagnose the indication. - `bmi_kg_m2` (number, required): Body-mass index in kg/m^2 (10-80). Caller-supplied; magent does not compute BMI from height and weight. Bharamgoudar 2018 Table 3: <25 scores 0; 25-35 inclusive scores 1; >35 scores 2. 25.0 and 35.0 score 1; 36 scores 2. - `cbd_diameter` (string, required): Caller-assigned common bile duct diameter (Bharamgoudar 2018 Table 3). normal scores 0; dilated scores 2. magent does not image the gallbladder or measure the CBD. - `gallbladder_wall` (string, required): Caller-assigned gallbladder wall (Bharamgoudar 2018 Table 3). normal scores 0; thick scores 1.5. magent does not image the gallbladder. - `pre_operative_ct` (boolean, required): Pre-operative CT as assigned by the caller (Bharamgoudar 2018 Table 3). true scores 1.5. magent does not read imaging. - `planned_intraop_cholangiogram` (boolean, required): Planned intraoperative cholangiogram as assigned by the caller (Bharamgoudar 2018 Table 3). true scores 3. magent does not plan the operation. - `previous_surgical_admissions` (integer, required): Previous surgical admissions, integer 0-20 (Bharamgoudar 2018 Table 3). 0 scores 0; 1-2 scores 1; >2 scores 2.5. - `asa_class` (integer, required): ASA physical status class, integer 1-5 (Bharamgoudar 2018 Table 3; Gupta 2011 1-5 range). 1 scores 0; 2 scores 1; 3-5 scores 2.5. magent does not assign ASA class. ## Bulk (POST) POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement. Method: `POST /api/calc/choles_score` Max items: 25 Price: unit_amount + extra_item_amount * (n - 1) (unit 5000 atomic, extra 2000 atomic) Status: PREVIEW - 1 to 25 items. Each item uses the same keys as the GET query parameters. - POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows. - The first invalid item fails the whole request (index in the 400 JSON). You are not charged. - HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row. - Catalog misses (empty matches, found=false) stay paid 200s inside that slot. - x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items. Example request: ```json { "items": [ { "age": "35", "asa_class": "1", "bmi_kg_m2": "24", "cbd_diameter": "normal", "gallbladder_wall": "normal", "indication": "pancreatitis", "planned_intraop_cholangiogram": "false", "pre_operative_ct": "false", "previous_surgical_admissions": "0", "sex": "female" }, { "age": "35", "asa_class": "1", "bmi_kg_m2": "24", "cbd_diameter": "normal", "gallbladder_wall": "normal", "indication": "pancreatitis", "planned_intraop_cholangiogram": "false", "pre_operative_ct": "false", "previous_surgical_admissions": "0", "sex": "female" } ] } ``` Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/choles-score Example 200: ```json { "count": 2, "path": "/api/calc/choles_score", "items": [ { "components": [ { "value": 35, "factor": "age", "points": 0, "present": true }, { "value": "female", "factor": "sex", "points": 0, "present": true }, { "value": "pancreatitis", "factor": "indication", "points": 0, "present": true }, { "value": 24.0, "factor": "bmi_kg_m2", "points": 0, "present": true }, { "value": "normal", "factor": "cbd_diameter", "points": 0, "present": true }, { "value": "normal", "factor": "gallbladder_wall", "points": 0, "present": true }, { "factor": "pre_operative_ct", "points": 0, "present": true }, { "factor": "planned_intraop_cholangiogram", "points": 0, "present": true }, { "value": 0, "factor": "previous_surgical_admissions", "points": 0, "present": true }, { "value": 1, "factor": "asa_class", "points": 0, "present": true } ], "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "Bharamgoudar R, Sonsale A, Hodson J, Griffiths E; CholeS Study Group, West Midlands Research Collaborative", "doi": "10.1007/s00464-018-6030-6", "id": "bharamgoudar-2018", "pmid": "29340820", "source": "Surg Endosc. 2018;32(7):3149-3157", "title": "The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy" }, "formula": "choles_score", "formula_expression": "CholeS = age (<40 0, >=40 1.5) + sex (female 0, male 1) + indication (pancreatitis 0, colic_dyskinesia_polyp 0.5, cbd_stone 2, acalculous_cholecystitis 2.5) + bmi_kg_m2 (<25 0, 25-35 inclusive 1, >35 2) + cbd_diameter (normal 0, dilated 2) + gallbladder_wall (normal 0, thick 1.5) + pre_operative_ct (true 1.5) + planned_intraop_cholangiogram (true 3) + previous_surgical_admissions (0 0, 1-2 1, >2 2.5) + asa_class (1 0, 2 1, 3-5 2.5); Bharamgoudar 2018 Table 3; max 20; numeric total only, no duration or risk bands", "max_score": 20, "score": 0, "age_years": 35, "sex": "female", "asa_class": 1, "bmi_kg_m2": 24.0, "cbd_diameter": "normal", "gallbladder_wall": "normal", "indication": "pancreatitis", "planned_intraop_cholangiogram": false, "pre_operative_ct": false, "previous_surgical_admissions": 0 }, { "components": [ { "value": 35, "factor": "age", "points": 0, "present": true }, { "value": "female", "factor": "sex", "points": 0, "present": true }, { "value": "pancreatitis", "factor": "indication", "points": 0, "present": true }, { "value": 24.0, "factor": "bmi_kg_m2", "points": 0, "present": true }, { "value": "normal", "factor": "cbd_diameter", "points": 0, "present": true }, { "value": "normal", "factor": "gallbladder_wall", "points": 0, "present": true }, { "factor": "pre_operative_ct", "points": 0, "present": true }, { "factor": "planned_intraop_cholangiogram", "points": 0, "present": true }, { "value": 0, "factor": "previous_surgical_admissions", "points": 0, "present": true }, { "value": 1, "factor": "asa_class", "points": 0, "present": true } ], "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "Bharamgoudar R, Sonsale A, Hodson J, Griffiths E; CholeS Study Group, West Midlands Research Collaborative", "doi": "10.1007/s00464-018-6030-6", "id": "bharamgoudar-2018", "pmid": "29340820", "source": "Surg Endosc. 2018;32(7):3149-3157", "title": "The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy" }, "formula": "choles_score", "formula_expression": "CholeS = age (<40 0, >=40 1.5) + sex (female 0, male 1) + indication (pancreatitis 0, colic_dyskinesia_polyp 0.5, cbd_stone 2, acalculous_cholecystitis 2.5) + bmi_kg_m2 (<25 0, 25-35 inclusive 1, >35 2) + cbd_diameter (normal 0, dilated 2) + gallbladder_wall (normal 0, thick 1.5) + pre_operative_ct (true 1.5) + planned_intraop_cholangiogram (true 3) + previous_surgical_admissions (0 0, 1-2 1, >2 2.5) + asa_class (1 0, 2 1, 3-5 2.5); Bharamgoudar 2018 Table 3; max 20; numeric total only, no duration or risk bands", "max_score": 20, "score": 0, "age_years": 35, "sex": "female", "asa_class": 1, "bmi_kg_m2": 24.0, "cbd_diameter": "normal", "gallbladder_wall": "normal", "indication": "pancreatitis", "planned_intraop_cholangiogram": false, "pre_operative_ct": false, "previous_surgical_admissions": 0 } ] } ``` ## Response fields - `formula` (string): choles_score - `formula_expression` (string): Exact expression used - `score` (number): Bharamgoudar 2018 Table 3 points 0-20 (half-points allowed; not integer-rounded). Numeric total only; not a duration or risk band. - `max_score` (integer): Always 20 - `age_years` (integer): Age used for the exclusive age band - `sex` (string): female or male used for the sex points - `indication` (string): Exclusive indication used (pancreatitis, colic_dyskinesia_polyp, cbd_stone, or acalculous_cholecystitis) - `bmi_kg_m2` (number): BMI in kg/m^2 used for the exclusive BMI band - `cbd_diameter` (string): Caller-assigned CBD diameter used (normal or dilated) - `gallbladder_wall` (string): Caller-assigned gallbladder wall used (normal or thick) - `pre_operative_ct` (boolean): Whether pre-operative CT was assigned true - `planned_intraop_cholangiogram` (boolean): Whether planned intraoperative cholangiogram was assigned true - `previous_surgical_admissions` (integer): Previous surgical admissions used (0-20) - `asa_class` (integer): ASA class used (1-5) - `components` (array): Per-factor Bharamgoudar 2018 Table 3 points - `citation` (object): Bharamgoudar et al. Surg Endosc 2018 citation - `disclaimer` (string): Not-a-device notice ## Example JSON Frozen fixture. Not a live lookup. ```json { "components": [ { "value": 35, "factor": "age", "points": 0, "present": true }, { "value": "female", "factor": "sex", "points": 0, "present": true }, { "value": "pancreatitis", "factor": "indication", "points": 0, "present": true }, { "value": 24.0, "factor": "bmi_kg_m2", "points": 0, "present": true }, { "value": "normal", "factor": "cbd_diameter", "points": 0, "present": true }, { "value": "normal", "factor": "gallbladder_wall", "points": 0, "present": true }, { "factor": "pre_operative_ct", "points": 0, "present": true }, { "factor": "planned_intraop_cholangiogram", "points": 0, "present": true }, { "value": 0, "factor": "previous_surgical_admissions", "points": 0, "present": true }, { "value": 1, "factor": "asa_class", "points": 0, "present": true } ], "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "Bharamgoudar R, Sonsale A, Hodson J, Griffiths E; CholeS Study Group, West Midlands Research Collaborative", "doi": "10.1007/s00464-018-6030-6", "id": "bharamgoudar-2018", "pmid": "29340820", "source": "Surg Endosc. 2018;32(7):3149-3157", "title": "The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy" }, "formula": "choles_score", "formula_expression": "CholeS = age (<40 0, >=40 1.5) + sex (female 0, male 1) + indication (pancreatitis 0, colic_dyskinesia_polyp 0.5, cbd_stone 2, acalculous_cholecystitis 2.5) + bmi_kg_m2 (<25 0, 25-35 inclusive 1, >35 2) + cbd_diameter (normal 0, dilated 2) + gallbladder_wall (normal 0, thick 1.5) + pre_operative_ct (true 1.5) + planned_intraop_cholangiogram (true 3) + previous_surgical_admissions (0 0, 1-2 1, >2 2.5) + asa_class (1 0, 2 1, 3-5 2.5); Bharamgoudar 2018 Table 3; max 20; numeric total only, no duration or risk bands", "max_score": 20, "score": 0, "age_years": 35, "sex": "female", "asa_class": 1, "bmi_kg_m2": 24.0, "cbd_diameter": "normal", "gallbladder_wall": "normal", "indication": "pancreatitis", "planned_intraop_cholangiogram": false, "pre_operative_ct": false, "previous_surgical_admissions": 0 } ``` ## Errors - HTTP 400 `invalid_age`: age must be an integer from 18 to 120 Returned before settlement; you are not charged. - HTTP 400 `invalid_sex`: sex must be female or male Returned before settlement; you are not charged. - HTTP 400 `invalid_bmi_kg_m2`: bmi_kg_m2 must be a number from 10 to 80. Returned before settlement; you are not charged. - HTTP 400 `invalid_asa_class`: asa_class must be an integer from 1 to 5 (Gupta 2011 ASA physical status). Returned before settlement; you are not charged. - HTTP 400 `invalid_flag`: boolean clinical flags must be true or false Returned before settlement; you are not charged. - HTTP 400 `invalid_choles`: indication must be pancreatitis, colic_dyskinesia_polyp, cbd_stone, or acalculous_cholecystitis; cbd_diameter normal or dilated; gallbladder_wall normal or thick; previous_surgical_admissions an integer 0-20 (Bharamgoudar 2018 CholeS Table 3). Returned before settlement; you are not charged. - HTTP 400 `invalid_items`: POST body must be a JSON object with only an items array Returned before settlement; you are not charged. - HTTP 400 `invalid_item_count`: items must be an array of 1 to 25 objects Returned before settlement; you are not charged. - HTTP 400 `invalid_item`: each items entry must be a JSON object Returned before settlement; you are not charged. Shared HTTP 402 and 503: https://magentlab.com/docs/payments ## Related tools - [Tokyo cholangitis](https://magentlab.com/docs/tokyo-cholangitis) — Apply Kiriyama 2018 Tokyo Guidelines 2018 diagnostic criteria and severity grading of acute cholangitis (unchanged from TG13) and return diagnosis (definite, suspected, or none) and severity (grade_i, grade_ii, grade_iii, or none) from caller-assigned flags and age. - [Tokyo cholecystitis](https://magentlab.com/docs/tokyo-cholecystitis) — Apply Yokoe 2018 Tokyo Guidelines 2018 diagnostic criteria and severity grading of acute cholecystitis (unchanged from TG13) and return diagnosis (definite, suspected, or none) and severity (grade_i, grade_ii, grade_iii, or none) from caller-assigned flags. ## Payment Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s. - GET the tool with Accept: application/json (do not send Accept: text/html unless you want the human paywall). - HTTP 402 means you have not paid. Decode the base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote. - Sign accepts[0] (exact, EIP-3009) with validBefore = now + maxTimeoutSeconds (600 seconds), or accepts[1] (batch-settlement deposit/voucher) on product GET. Ping and POST {items} stay exact. Magent retries transient facilitator 429/5xx before answering. - Retry the same URL with PAYMENT-SIGNATURE (base64 JSON of accepted and payload). Magent attaches canonical extensions.bazaar on CDP verify/settle; echoing 402 bazaar is optional. - Success is HTTP 200 JSON plus PAYMENT-RESPONSE. exact settles before the tool. batch-settlement verifies (and deposit-settles) before the tool and commits the charge after HTTP 2xx. HTTP 503: retry the same PAYMENT-SIGNATURE. Mint a new exact nonce only after a new HTTP 402. - offered `exact` on eip155:8453: Fixed-price USDC on Base. The buyer authorizes the advertised amount (EIP-3009). magent settles before the tool runs (paymentFlow upfront). extra.assetTransferMethod=eip3009 extra.paymentFlow=upfront. - offered `batch-settlement` on eip155:8453: Payment-channel vouchers claimed later in batches. Exact stays accepts[0]. Same-path POST {items} is still exact. extra.assetTransferMethod=eip3009 extra.paymentFlow=authorization. - not offered `upto`: Not offered. Usage-based: buyer authorizes a ceiling, seller settles the actual amount after work. Reserved for a future metered tool. Not for current calculators or code search. Same-path POST {items} is still scheme exact: one EIP-3009 authorization for GET unit plus $0.002 per extra item. That is not x402 batch-settlement (payment channels / vouchers). Shared HTTP 402 and 503 table: https://magentlab.com/docs/payments Stdio MCP (one process per host): https://magentlab.com/docs/mcp ## Guarantees - HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged. HTTP 402 never includes the tool JSON. - exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE. - HTTP 402 is unpaid only. Do not sign a second authorization because of a 503. - Execution is timeout-bounded and concurrency-capped. - Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.