Ahmad H M Nassar1, James Hodson2, Hwei J Ng1, Ravi S Vohra3, Tarek Katbeh1, Samer Zino1, Ewen A Griffiths4,5,6. 1. Department of Surgery, University Hospital Monklands, Lanarkshire, Scotland, UK. 2. Institute of Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK. 3. Trent Oesophago-Gastric Unit, Nottingham University Hospitals NHS Trust, Nottingham, UK. 4. Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK. ewen.griffiths@uhb.nhs.uk. 5. Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK. ewen.griffiths@uhb.nhs.uk. 6. Department of Upper Gastrointestinal Surgery, Queen Elizabeth Hospital Birmingham, Area 6, 7th Floor, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK. ewen.griffiths@uhb.nhs.uk.
Abstract
BACKGROUND: The prediction of a difficult cholecystectomy has traditionally been based on certain pre-operative clinical and imaging factors. Most of the previous literature reported small patient cohorts and have not used an objective measure of operative difficulty. The aim of this study was to develop a pre-operative score to predict difficult cholecystectomy, as defined by a validated intra-operative difficulty grading scale. METHOD: Two cohorts from prospectively maintained databases of patients who underwent laparoscopic cholecystectomy were analysed: the CholeS Study (8755 patients) and a single surgeon series (4089 patients). Factors potentially predictive of difficulty were correlated to the Nassar intra-operative difficulty scale. A multivariable binary logistic regression analysis was then used to identify factors that were independently associated with difficult laparoscopic cholecystectomy, defined as operative difficulty grades 3 to 5. The resulting model was then converted to a risk score, and validated on both internal and external datasets. RESULT: Increasing age and ASA classification, male gender, diagnosis of CBD stone or cholecystitis, thick-walled gallbladders, CBD dilation, use of pre-operative ERCP and non-elective operations were found to be significant independent predictors of difficult cases. A risk score based on these factors returned an area under the ROC curve of 0.789 (95% CI 0.773-0.806, p < 0.001) on external validation, with 11.0% versus 80.0% of patients classified as low versus high risk having difficult surgeries. CONCLUSION: We have developed and validated a pre-operative scoring system that uses easily available pre-operative variables to predict difficult laparoscopic cholecystectomies. This scoring system should assist in patient selection for day case surgery, optimising pre-operative surgical planning (e.g. allocation of the procedure to a suitably trained surgeon) and counselling patients during the consent process. The score could also be used to risk adjust outcomes in future research.
BACKGROUND: The prediction of a difficult cholecystectomy has traditionally been based on certain pre-operative clinical and imaging factors. Most of the previous literature reported small patient cohorts and have not used an objective measure of operative difficulty. The aim of this study was to develop a pre-operative score to predict difficult cholecystectomy, as defined by a validated intra-operative difficulty grading scale. METHOD: Two cohorts from prospectively maintained databases of patients who underwent laparoscopic cholecystectomy were analysed: the CholeS Study (8755 patients) and a single surgeon series (4089 patients). Factors potentially predictive of difficulty were correlated to the Nassar intra-operative difficulty scale. A multivariable binary logistic regression analysis was then used to identify factors that were independently associated with difficult laparoscopic cholecystectomy, defined as operative difficulty grades 3 to 5. The resulting model was then converted to a risk score, and validated on both internal and external datasets. RESULT: Increasing age and ASA classification, male gender, diagnosis of CBD stone or cholecystitis, thick-walled gallbladders, CBD dilation, use of pre-operative ERCP and non-elective operations were found to be significant independent predictors of difficult cases. A risk score based on these factors returned an area under the ROC curve of 0.789 (95% CI 0.773-0.806, p < 0.001) on external validation, with 11.0% versus 80.0% of patients classified as low versus high risk having difficult surgeries. CONCLUSION: We have developed and validated a pre-operative scoring system that uses easily available pre-operative variables to predict difficult laparoscopic cholecystectomies. This scoring system should assist in patient selection for day case surgery, optimising pre-operative surgical planning (e.g. allocation of the procedure to a suitably trained surgeon) and counselling patients during the consent process. The score could also be used to risk adjust outcomes in future research.
Authors: Niall O'Connor; Michael Sugrue; Conor Melly; Gearoid McGeehan; Magda Bucholc; Aileen Crawford; Paul O'Connor; Fikri Abu-Zidan; Imtiaz Wani; Zsolt J Balogh; Vishal G Shelat; Giovanni D Tebala; Belinda De Simone; Hani O Eid; Mircea Chirica; Gustavo P Fraga; Salomone Di Saverio; Edoardo Picetti; Luigi Bonavina; Marco Ceresoli; Andreas Fette; Boris Sakakushe; Emmanouil Pikoulis; Raul Coimbra; Richard Ten Broek; Andreas Hecker; Ari Leppäniemi; Andrey Litvin; Philip Stahel; Edward Tan; Kaoru Koike; Fausto Catena; Michele Pisano; Federico Coccolini; Alison Johnston Journal: World J Emerg Surg Date: 2022-03-17 Impact factor: 5.469
Authors: Laura Alberici; Alessandro M Paganini; Francesco Minni; Guido Alberto Massimo Tiberio; Claudio Ricci; Andrea Balla; Zeno Ballarini; Monica Ortenzi; Giovanni Casole; Silvia Quaresima; Guido Di Dalmazi; Pietro Ursi; Marie Sophie Alfano; Saverio Selva; Riccardo Casadei; Carlo Ingaldi; Giovanni Lezoche; Mario Guerrieri Journal: Surg Endosc Date: 2021-08-17 Impact factor: 4.584
Authors: Ahmad H M Nassar; Hwei J Ng; Zubir Ahmed; Arkadiusz Peter Wysocki; Colin Wood; Ayman Abdellatif Journal: Surg Endosc Date: 2020-08-28 Impact factor: 4.584