Conference item
Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy
- Abstract:
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Background
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.
Methods
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.
Results
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).
Conclusion
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.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
Actions
Access Document
- Files:
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(Preview, Version of record, pdf, 1.3MB, Terms of use)
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- Publisher copy:
- 10.1007/s00464-018-6281-2
Authors
Contributors
- Institution:
- University of Oxford
- Division:
- Medical Sciences Division
- Department:
- NDM
- Sub department:
- Oxford Ludwig Institute
- Department:
- Unknown
- Role:
- Contributor
- ORCID:
- 0000-0001-7878-7024
- Role:
- Contributor
- Publisher:
- Springer Verlag
- Host title:
- Surgical Endoscopy
- Journal:
- Surgical Endoscopy More from this journal
- Volume:
- 33
- Issue:
- 1
- Pages:
- 110-121
- Publication date:
- 2018-06-28
- Acceptance date:
- 2018-06-18
- Event location:
- Germany
- DOI:
- EISSN:
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1432-2218
- ISSN:
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0930-2794
- Pmid:
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29956029
- Keywords:
- Pubs id:
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pubs:969053
- UUID:
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uuid:658d5f45-e85f-4e24-8d0c-d25226a2e184
- Local pid:
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pubs:969053
- Source identifiers:
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969053
- Deposit date:
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2019-02-13
Terms of use
- Copyright holder:
- Griffiths et al
- Copyright date:
- 2018
- Notes:
- © The Author(s) 2018. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
- Licence:
- CC Attribution (CC BY)
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