Robert P Sutcliffe1, Marianne Hollyman2, James Hodson3, Glenn Bonney4, Ravi S Vohra5, Ewen A Griffiths6. 1. Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK. Electronic address: robert.sutcliffe@uhb.nhs.uk. 2. West Midlands Research Collaborative, Academic Department of Surgery, Birmingham University, UK. 3. Institute of Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK. 4. Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK. 5. Nottingham Oesophago-Gastric Unit, Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK. 6. Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Abstract
BACKGROUND: Laparoscopic cholecystectomy is commonly performed, and several factors increase the risk of open conversion, prolonging operating time and hospital stay. Preoperative stratification would improve consent, scheduling and identify appropriate training cases. The aim of this study was to develop a validated risk score for conversion for use in clinical practice. PATIENTS AND METHODS: Preoperative patient and disease-related variables were identified from a prospective cholecystectomy database (CholeS) of 8820 patients, divided into main and validation sets. Preoperative predictors of conversion were identified by multivariable binary logistic regression. A risk score was developed and validated using a forward stepwise approach. RESULTS: Some 297 procedures (3.4%) were converted. The risk score was derived from six significant predictors: age (p = 0.005), sex (p < 0.001), indication for surgery (p < 0.001), ASA (p < 0.001), thick-walled gallbladder (p = 0.040) and CBD diameter (p = 0.004). Testing the score on the validation set yielded an AUROC = 0.766 (p < 0.001), and a score >6 identified patients at high risk of conversion (7.1% vs. 1.2%). CONCLUSION: This validated risk score allows preoperative identification of patients at six-fold increased risk of conversion to open cholecystectomy.
BACKGROUND: Laparoscopic cholecystectomy is commonly performed, and several factors increase the risk of open conversion, prolonging operating time and hospital stay. Preoperative stratification would improve consent, scheduling and identify appropriate training cases. The aim of this study was to develop a validated risk score for conversion for use in clinical practice. PATIENTS AND METHODS: Preoperative patient and disease-related variables were identified from a prospective cholecystectomy database (CholeS) of 8820 patients, divided into main and validation sets. Preoperative predictors of conversion were identified by multivariable binary logistic regression. A risk score was developed and validated using a forward stepwise approach. RESULTS: Some 297 procedures (3.4%) were converted. The risk score was derived from six significant predictors: age (p = 0.005), sex (p < 0.001), indication for surgery (p < 0.001), ASA (p < 0.001), thick-walled gallbladder (p = 0.040) and CBD diameter (p = 0.004). Testing the score on the validation set yielded an AUROC = 0.766 (p < 0.001), and a score >6 identified patients at high risk of conversion (7.1% vs. 1.2%). CONCLUSION: This validated risk score allows preoperative identification of patients at six-fold increased risk of conversion to open cholecystectomy.
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