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- Title
Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy.
- Authors
Griffiths, Ewen A.; Hodson, James; Vohra, Ravi S.; Marriott, Paul; Katbeh, Tarek; Zino, Samer; Nassar, Ahmad H. M.; West Midlands Research Collaborative
- Abstract
<bold>Background: </bold>A reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets.<bold>Methods: </bold>Patient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendall's tau for dichotomous variables, or Jonckheere-Terpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis.<bold>Results: </bold>A higher operative difficulty grade was consistently associated with worse outcomes for the patients in both the reference and CholeS cohorts. The median length of stay increased from 0 to 4 days, and the 30-day complication rate from 7.6 to 24.4% as the difficulty grade increased from 1 to 4/5 (both p < 0.001). In the CholeS cohort, a higher difficulty grade was found to be most strongly associated with conversion to open and 30-day mortality (AUROC = 0.903, 0.822, respectively). On multivariable analysis, the Nassar operative difficultly scale was found to be a significant independent predictor of operative duration, conversion to open surgery, 30-day complications and 30-day reintervention (all p < 0.001).<bold>Conclusion: </bold>We have shown that an operative difficulty scale can standardise the description of operative findings by multiple grades of surgeons to facilitate audit, training assessment and research. It provides a tool for reporting operative findings, disease severity and technical difficulty and can be utilised in future research to reliably compare outcomes according to case mix and intra-operative difficulty.
- Subjects
CHOLECYSTECTOMY; LAPAROSCOPIC surgery; RANK correlation (Statistics); GALLBLADDER surgery; OPERATIVE surgery; LENGTH of stay in hospitals; LONGITUDINAL method; MULTIVARIATE analysis; SURGICAL complications; RECEIVER operating characteristic curves
- Publication
Surgical Endoscopy & Other Interventional Techniques, 2019, Vol 33, Issue 1, p110
- ISSN
1866-6817
- Publication type
journal article
- DOI
10.1007/s00464-018-6281-2