Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy.

Griffiths, Ewen A, Hodson, James, Vohra, Ravi S, Marriott, Paul, Katbeh, Tarek, Zino, Samer and Nassar, Ahmad H M (2019) Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy. Surgical endoscopy, 33 (1). pp. 110-121. ISSN 1432-2218. This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs.

Full text not available from this repository.
Official URL: https://link.springer.com/article/10.1007/s00464-0...

Abstract

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.

Item Type: Article
Additional Information: This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs.
Subjects: WI Digestive system. Gastroenterology
WO Surgery
Divisions: Clinical Support
Planned IP Care > Gastroentrology
Related URLs:
Depositing User: Mrs Noomi Tyholdt-Pidgley
Date Deposited: 06 May 2020 14:32
Last Modified: 06 May 2020 14:32
URI: http://www.repository.uhblibrary.co.uk/id/eprint/3045

Actions (login required)

View Item View Item