Stéphane Bourgouin1, Julien Mancini2, Tristan Monchal3, Ronan Calvary3, Julien Bordes4, Paul Balandraud3. 1. Sainte Anne Military Teaching Hospital, Department of Oncologic and Digestive Surgery, Toulon, France. Electronic address: stephane_bourgouin@hotmail.fr. 2. Aix-Marseille University, UMR912 SESSTIM, Inserm, IRD; APHM La Timone, Department of Public Health, Marseille, France. 3. Sainte Anne Military Teaching Hospital, Department of Oncologic and Digestive Surgery, Toulon, France. 4. Sainte Anne Military Teaching Hospital, Department of Anesthesia and Intensive Care, Toulon, France.
Abstract
BACKGROUND: Few studies have used operative time as a reflection of the surgical difficulty to create a preoperative score of operative difficulty in laparoscopic cholecystectomies (DiLCs score). METHODS: Patients who benefited from cholecystectomy between 2010 and 2015 were reviewed. Difficult procedures were identified using the deviations from the operative time for simple cholecystectomies. Logistic regression analyses were carried out to build risk-assessment models and derive the DiLC score. RESULTS: Overall, 644 patients were identified. Multivariate analyses identified male sex, previous cholecystitis attack, fibrinogen, neutrophil, and alkaline phosphatase count to be predictive of operative difficulties. Risk-assessment model was generated with an area under the receiver-operator curve of .80. Internal validation was performed using the bootstrap method. CONCLUSIONS: The DiLC score is a simple and reliable tool which could be used to improve patient counseling, optimize surgical planning, detect procedures at risk, identify patients eligible for outpatient care, and enhance resident training.
BACKGROUND: Few studies have used operative time as a reflection of the surgical difficulty to create a preoperative score of operative difficulty in laparoscopic cholecystectomies (DiLCs score). METHODS:Patients who benefited from cholecystectomy between 2010 and 2015 were reviewed. Difficult procedures were identified using the deviations from the operative time for simple cholecystectomies. Logistic regression analyses were carried out to build risk-assessment models and derive the DiLC score. RESULTS: Overall, 644 patients were identified. Multivariate analyses identified male sex, previous cholecystitis attack, fibrinogen, neutrophil, and alkaline phosphatase count to be predictive of operative difficulties. Risk-assessment model was generated with an area under the receiver-operator curve of .80. Internal validation was performed using the bootstrap method. CONCLUSIONS: The DiLC score is a simple and reliable tool which could be used to improve patient counseling, optimize surgical planning, detect procedures at risk, identify patients eligible for outpatient care, and enhance resident training.
Authors: Alba Manuel-Vázquez; Raquel Latorre-Fragua; Carmen Ramiro-Pérez; Aylhin López-Marcano; Farah Al-Shwely; Roberto De la Plaza-Llamas; José Manuel Ramia Journal: World J Gastroenterol Date: 2017-04-28 Impact factor: 5.742
Authors: Sarah Z Wennmacker; Nazim Bhimani; Aafke H van Dijk; Thomas J Hugh; Philip R de Reuver Journal: ANZ J Surg Date: 2019-10-22 Impact factor: 1.872