Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy
<p><strong>Background</strong><br/> 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), testin...
| Main Authors: | , , , , , , |
|---|---|
| Other Authors: | |
| Format: | Conference item |
| Published: |
Springer Verlag
2018
|
| _version_ | 1797072689415847936 |
|---|---|
| author | Griffiths, E Hodson, J Vohra, R Marriott, P Katbeh, T Zino, S Nassar, A |
| author2 | Segaran, A |
| author_facet | Segaran, A Griffiths, E Hodson, J Vohra, R Marriott, P Katbeh, T Zino, S Nassar, A |
| author_sort | Griffiths, E |
| collection | OXFORD |
| description | <p><strong>Background</strong><br/> 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.</p><br/> <p><strong>Methods</strong><br/> 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.</p><br/> <p><strong>Results</strong><br/> 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).</p><br/> <p><strong>Conclusion</strong><br/> 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.</p><br/> |
| first_indexed | 2024-03-06T23:11:16Z |
| format | Conference item |
| id | oxford-uuid:658d5f45-e85f-4e24-8d0c-d25226a2e184 |
| institution | University of Oxford |
| last_indexed | 2024-03-06T23:11:16Z |
| publishDate | 2018 |
| publisher | Springer Verlag |
| record_format | dspace |
| spelling | oxford-uuid:658d5f45-e85f-4e24-8d0c-d25226a2e1842022-03-26T18:26:13ZUtilisation of an operative difficulty grading scale for laparoscopic cholecystectomyConference itemhttp://purl.org/coar/resource_type/c_5794uuid:658d5f45-e85f-4e24-8d0c-d25226a2e184Symplectic Elements at OxfordSpringer Verlag2018Griffiths, EHodson, JVohra, RMarriott, PKatbeh, TZino, SNassar, ASegaran, AWest Midlands Research Collaborative,<p><strong>Background</strong><br/> 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.</p><br/> <p><strong>Methods</strong><br/> 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.</p><br/> <p><strong>Results</strong><br/> 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).</p><br/> <p><strong>Conclusion</strong><br/> 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.</p><br/> |
| spellingShingle | Griffiths, E Hodson, J Vohra, R Marriott, P Katbeh, T Zino, S Nassar, A Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy |
| title | Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy |
| title_full | Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy |
| title_fullStr | Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy |
| title_full_unstemmed | Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy |
| title_short | Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy |
| title_sort | utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy |
| work_keys_str_mv | AT griffithse utilisationofanoperativedifficultygradingscaleforlaparoscopiccholecystectomy AT hodsonj utilisationofanoperativedifficultygradingscaleforlaparoscopiccholecystectomy AT vohrar utilisationofanoperativedifficultygradingscaleforlaparoscopiccholecystectomy AT marriottp utilisationofanoperativedifficultygradingscaleforlaparoscopiccholecystectomy AT katbeht utilisationofanoperativedifficultygradingscaleforlaparoscopiccholecystectomy AT zinos utilisationofanoperativedifficultygradingscaleforlaparoscopiccholecystectomy AT nassara utilisationofanoperativedifficultygradingscaleforlaparoscopiccholecystectomy |