Predicting the difficult laparoscopic cholecystectomy: development and validation of a pre-operative risk score using an objective operative difficulty grading system

Predicting the difficult laparoscopic cholecystectomy: development and validation of a pre-operative risk score using an objective operative difficulty grading system

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 dev...

Full description

Saved in:
Bibliographic Details
Published in:Surgical endoscopy 2020-10, Vol.34 (10), p.4549-4561
Main Authors: Nassar, Ahmad H. M., Hodson, James, Ng, Hwei J., Vohra, Ravi S., Katbeh, Tarek, Zino, Samer, Griffiths, Ewen A.
Format: Article
Language:eng
Subjects:
Abdominal Surgery
Adult
Cholecystectomy
Cholecystectomy, Laparoscopic
Cohort Studies
Female
Gastroenterology
Gynecology
Hepatology
Humans
Laparoscopy
Male
Medicine
Medicine & Public Health
Middle Aged
Multivariate Analysis
Patients
Preoperative Care
Proctology
Reproducibility of Results
Risk Factors
ROC Curve
Surgeons
Surgery
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary: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  
ISSN:0930-2794
1432-2218