Validation of the AAST EGS acute cholecystitis grade and comparison with the Tokyo guidelines

Hernandez, Matthew C.; Murphy, Brittany L.; Aho, J. M.; Haddad, Nadeem N.; Saleem, Humza Y.; Zeb, Muhammad H.; Morris, David S.; Jenkins, Donald H.; Zielinski, Martin D.

doi:10.1016/j.surg.2017.10.041

Cited by 46 publications

(23 citation statements)

References 35 publications

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“…Other large series have somewhat similar conversion rates although Hu and colleagues report only a 4% conversion rate [6, 11, 25]. There is extreme variability in the conversion rate in our study, and there is no reason to believe this does not reflect true practice.…”

Section: Discussionsupporting

confidence: 42%

“…Some of these scores are based on preoperative clinical findings, and imaging, but only concentrate on actual operative findings limiting their use. Recently, the AAST scoring system has been validated and it has been suggested that it is superior to the 2013 Tokyo classification in part due to the greater number of grades of cholecystitis with the AAST classification [11]. The Tokyo guidelines for classifying cholecystitis use three grades, without robust inclusion of the operative findings [12].…”

Section: Introductionmentioning

confidence: 99%

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Intra-operative gallbladder scoring predicts conversion of laparoscopic to open cholecystectomy: a WSES prospective collaborative study

Sugrue

Catena

Bucholc³

et al. 2019

World J Emerg Surg

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IntroductionLaparoscopic cholecystectomy, the gold-standard approach for cholecystectomy, has surprisingly variable outcomes and conversion rates. Only recently has operative grading been reported to define disease severity and few have been validated. This multicentre, multinational study assessed an operative scoring system to assess its ability to predict the need for conversion from laparoscopic to open cholecystectomy.MethodsA prospective, web-based, ethically approved study was established by WSES with a 10-point gallbladder operative scoring system; enrolling patients undergoing elective or emergency laparoscopic cholecystectomy between January 2016 and December 2017. Gallbladder surgery was considered easy if the G10 score < 2, moderate (2 ≦ 4), difficult (5 ≦ 7) and extreme (8 ≦ 10). Demographics about the patients, surgeons and operative procedures, use of cholangiography and conversion rates were recorded.ResultsFive hundred four patients, mean age 53.5 (range 18–89), were enrolled by 55 surgeons in 16 countries. Surgery was performed by consultants in 70% and was elective in (56%) with a mean operative time of 78.7 min (range 15-400). The mean G10 score was 3.21, with 22% deemed to have difficult or extreme surgical gallbladders, and 71/504 patients were converted. The G10 score was 2.98 in those completed laparoscopically and 4.65 in the 71/504 (14%) converted. (p < 0.0001; AUC 0.772 (CI 0.719–0.825). The optimal cut-off point of 0.067 (score of 3) was identified in G10 vs conversion to open cholecystectomy. Conversion occurred in 33% of patients with G10 scores of ≥ 5. The four variables statistically predictive of conversion were GB appearance—completely buried GB, impacted stone, bile or pus outside GB and fistula.ConclusionThe G10 operative scores provide simple grading of operative cholecystectomy and are predictive of the need to convert to open cholecystectomy. Broader adaptation and validation may provide a benchmark to understand and improve care and afford more standardisation in global comparisons of care for cholecystectomy.

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Section: Discussionsupporting

confidence: 42%

Section: Introductionmentioning

confidence: 99%

Intra-operative gallbladder scoring predicts conversion of laparoscopic to open cholecystectomy: a WSES prospective collaborative study

Sugrue

Catena

Bucholc³

et al. 2019

World J Emerg Surg

View full text Add to dashboard Cite

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“…In each of these studies, the EGS grading scale was found to be associated with outcomes. [9][10][11] Though the EGS grading scale has been validated for a variety of different diseases, this study fills an important niche. In general, the EGS grading scales are specifically designed to address two main gaps.…”

Section: Discussionmentioning

confidence: 99%

“…Such a refinement is underway in regards to grading acute cholecystitis with incorporation of a real-time, intra-operative component. 11 Specifically in regards to STI, inclusion of physiologic parameters at the time of admission, perhaps in the form of the LRINEC score, as well as comorbid data will likely strengthen this scale.…”

Section: Discussionmentioning

confidence: 99%

The EGS grading scale for skin and soft-tissue infections is predictive of poor outcomes: a multicenter validation study

Savage

Utter

et al. 2019

J Trauma Acute Care Surg

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Introduction: Over the last five years, the American Association for the Surgery of Trauma (AAST) has developed grading scales for Emergency General Surgery (EGS) diseases. In a prior validation study using diverticulitis, the grading scales were predictive of complications and length of stay. As EGS encompasses diverse diseases, the purpose of this study was to validate the grading scale concept against a different disease process with a higher associated mortality.

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“…11 Several studies have demonstrated that AAST EGS grades facilitate multi-institutional outcomes research. [12][13][14][15][16][17] However, the potential of AAST EGS grades to propel real-time, point-of-care research has yet to be explored. We aimed to develop a clinical workflow that integrates prospective AAST EGS grade assignments within the electronic medical record (EMR) at the time of patient evaluation.…”

Section: Introductionmentioning

confidence: 99%

Creation and implementation of a novel clinical workflow based on the AAST uniform anatomic severity grading system for emergency general surgery conditions

Bessoff

Choi

Merrell

et al. 2020

Trauma Surg Acute Care Open

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ObjectiveEmergency general surgery (EGS) conditions encompass a variety of diseases treated by acute care surgeons. The heterogeneity of these diseases limits infrastructure to facilitate EGS-specific quality improvement (QI) and research. A uniform anatomic severity grading system for EGS conditions was recently developed to fill this need. We integrated this system into our clinical workflow and examined its impact on research, surgical training, communication, and patient care.MethodsThe grading system was integrated into our clinical workflow in a phased fashion through formal education and a written handbook. A documentation template was also deployed in our electronic medical record to prospectively assign severity scores at the time of patient evaluation. Mixed methods including a quantitative survey and qualitative interviews of trainees and attending surgeons were used to evaluate the impact of the new workflow and to identify obstacles to its adoption.ResultsWe identified 2291 patients presenting with EGS conditions during our study period. The most common diagnoses were small bowel obstruction (n=470, 20.5%), acute cholecystitis (n=384, 16.8%), and appendicitis (n=370, 16.1%). A total of 21 qualitative interviews were conducted. Twenty interviewees (95.2%) had a positive impression of the clinical workflow, citing enhanced patient care and research opportunities. Fifteen interviewees (75.0%) reported the severity grading system was a useful framework for clinical management, with five participants (25.0%) indicating the system was useful to facilitate clinical communication. Participants identified solutions to overcome barriers to adoption of the clinical workflow.ConclusionsThe uniform anatomic severity grading system can be readily integrated into a clinical workflow to facilitate prospective data collection for QI and research. The system is perceived as valuable by users. Educational initiatives that focus on increasing familiarity with the system and its benefits will likely improve adoption of the classification system and the clinical workflow that uses it.Level of evidenceLevel III.

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Validation of the AAST EGS acute cholecystitis grade and comparison with the Tokyo guidelines

Cited by 46 publications

References 35 publications

Intra-operative gallbladder scoring predicts conversion of laparoscopic to open cholecystectomy: a WSES prospective collaborative study

Intra-operative gallbladder scoring predicts conversion of laparoscopic to open cholecystectomy: a WSES prospective collaborative study

The EGS grading scale for skin and soft-tissue infections is predictive of poor outcomes: a multicenter validation study

Creation and implementation of a novel clinical workflow based on the AAST uniform anatomic severity grading system for emergency general surgery conditions

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