Risk prediction models for difficult cholecystectomy.

Abstract

Introduction In some cases, laparoscopic cholecystectomy (LC) may be very difficult and easily converted to laparotomy, causing many complications to patients and prolonging the prognosis time. Thus, to evaluate the difficulty of LC before operation is extremely important. Aim To explore the risk factors of difficult cholecystectomy (DC) and to establish a risk prediction model of DC. Material and methods The data of 201patients who underwent cholecystectomy from 1 January 2018 to 10 November 2019 were analysed retrospectively. The highest quartile (P75) of cholecystectomy operation time was used as a cutting point of DC (≥ P75) and NLC (< P75). Logistic regression was used to analyse the influencing factors of DC, and its risk model was constructed for prediction. Results Multivariate logistic regression analysis showed that body mass index (BMI) > 25 kg/m 2 , white blood cell (WBC) > 10 × 10 9 /l, calculus incarcerated in neck of gallbladder, frequency of acute cholecystitis in the last 2 months > 4 times, thickness of gallbladder wall > 0.5 cm, and maximum diameter of gallstone > 2 cm were independent risk factors for DC. The prediction efficiency of the logistic regression equation was 0.879 ( χ 2 = 1.457, p > 0.05). Conclusions Based on analysis of risk factors, a logistic risk prediction model for difficult cholecystectomy was established. This model can be used to predict the difficulty of cholecystectomy.

Frequency of Conversion of Laparoscopic Cholecystectomy to Open Cholecystectomy in a Low-Middle-Income Country

“…Obesity is a major patient factor which is known to be prevalent in patients who are eventually converted from LC to OC and our study reflected this as the majority (72.99%) of patients had a BMI above the norm, similar to Subhan, et al, Krishna, et al, and Chen G, et al [15,17,18]. Obese patients require consideration and counseling beforehand so that they can be involved in decision making prior to choosing a treatment modality.…”

Cystic Duct Dissection Time as a Predictor of Difficult Laparoscopic Cholecystectomy

“…[15,36,37,43] Although there are models predicting difficulty, they are complex and not practical. [7][8][9][10]24,25,34,44,[44][45][46][47][48] . To predict the use of a bailout procedure in a more practical way, we estimated the area under the ROC curve of the time (minutes) spent trying to dissect the CD and found that it predicts the use of bailout techniques, as well as being a good predictor of conversion (see Graphs 1 and 2).…”

“…[3][4][5][6] Possible reasons for the almost null use of prediction systems are implementation difficulties due to the complexity of such scales, making them impractical . [7][8][9][10] As prolongation of operative time is closely related to patient morbidity, most predictor scales include the time factor; however, while an experienced surgeon completes the cholecystectomy in >50% of his standard time, the values obtained do not apply to all. [11] Previous studies have documented that primary problems with Calot's triangle dissection are associated with difficulty; thus, hypothesizing that failure to complete Calot's triangle dissection within a predetermined period may be an early predictor of DLC and the development of complications.…”

Nomogram for predicting difficult total laparoscopic hysterectomy: a multi-institutional, retrospective model development and validation study

“…Ewen and colleagues developed a scoring system for laparoscopic cholecystectomy that utilized the preoperative patient characteristics to predict surgical complexity. The system demonstrated positive predictive values of 90% and 88% for uncomplicated and complex cases, respectively 16 – 18 . However, effective tools for predicting the operative difficulty in TLH are insufficient.…”