A risk score to predict the difficulty of elective laparoscopic cholecystectomy.

Abstract

IntroductionSeveral preoperative scoring systems have been proposed to predict the difficulty of laparoscopic cholecystectomy in order to optimize the results of surgical treatment by either selection of patients for the procedure or providing an adequately experienced surgical team for a given patient. Nevertheless, none of them has achieved significant penetration into everyday practice.AimTo propose and validate a novel risk score based on the patient's history, physical examination and abdominal ultrasonography parameters.Material and methodsThe risk score was defined by the presence of the following risk factors: male sex, biliary colic within the last 3 weeks prior to surgery, history of acute cholecystitis treated conservatively, previous upper abdominal surgery, right upper quadrant pain, rigidity in right upper abdomen and ultrasonographic parameters – thickening of the gallbladder wall ≥ 4 mm, hydropic gallbladder (diameter exceeding 4.5 cm) and shrunken gallbladder. One point was allocated for each risk factor, except for previous upper abdominal surgery, which scored two. Difficulty of the surgery was assessed by operating time (OT) and the postoperative subjective evaluation score (PSES).ResultsFive hundred and eighty-six consecutive patients were enrolled in the prospective observational study. A significant linear correlation was observed between the risk score and measures of difficulty employed. Five levels of difficulty were defined (score 0, 1, 2, 3, ≥ 4) with significant differences in OT, PSES and conversion rates (p < 0.001).ConclusionsThe suggested risk score is designed as a simple and reliable predictive model, possibly effective to overcome the negative effect of the individual proficiency gain curve and/or to select ‘easy’ cases for day surgery, single incision laparoscopic surgery or natural orifice translumenal endoscopic surgery procedures.

A clinical study to determine predictive factors for difficult laparoscopic cholecystectomy

“…[9,10] Pre-operative prediction becomes more important so that surgeons can be requested to be present during surgery and to avoid unnecessarily prolonging the surgery and to prevent complications. [11] In the present study, difficult LC was significantly more in patients with a history of previous abdominal surgery, tenderness in right hypochondrium, and thickening of GB, whereas conversion to OP was significantly high in patients with thickening of GB and distended or contracted GB.…”

Prediction of Surgical Difficulty in Laparoscopic Cholecystectomy for Acute Cholecystitis Performed Within 24 Hours After Hospital Admission

“…In previous reports looking at all gallbladder diseases, a number of risk factors for increased operation length and conversion rates have been established: male sex, previous history of acute cholecystitis, CRP elevation, gallbladder wall thickness, calculi, diabetes mellitus, obesity, and others. 7,[15][16][17][18] In previous studies involving only acute cholecystitis cases, Teckchandani et al 8 indicated that elevated WBC count, CRP, Alkaline phosphate, and amylase, as well as male sex, were risk factors for conversion, and Asai et al 19 identified longer presurgical symptom duration and elevated CRP as risk factors for conversion. Gallbladder thickness has been shown to be a significant predictor of laparoscopic cholecystectomy difficulty in several prior reports.…”

Application of Malmquist Indices in Valuation Process of Adult Day Surgery System in Slovakia

“…High efficiency and work rationalization represent advantages of day surgery for doctors. However, it may only be performed by experts who are able to estimate the result of postoperative recovery process (Šoltés & Radoňak, 2014). In Slovakia, 70 % of patients prefer sick leave over day surgery.…”