Griffiths, E. A., Hodson, J., Vohra, R. S., Marriott, P., Katbeh, T., Zino, S. and Nassar, A. H.M. (2019) Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy. Surgical Endoscopy, 33(1), pp. 110-121. (doi: 10.1007/s00464-018-6281-2) (PMID:29956029) (PMCID:PMC6336748)
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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: | Articles |
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Additional Information: | A correction to this article is available at https://doi.org/10.1007/s00464-018-6377-8. |
Status: | Published |
Refereed: | Yes |
Glasgow Author(s) Enlighten ID: | Zino, Mr Samer and Nassar, Mr Ahmad |
Authors: | Griffiths, E. A., Hodson, J., Vohra, R. S., Marriott, P., Katbeh, T., Zino, S., and Nassar, A. H.M. |
College/School: | College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing |
Journal Name: | Surgical Endoscopy |
Publisher: | Springer |
ISSN: | 0930-2794 |
ISSN (Online): | 1432-2218 |
Published Online: | 28 June 2018 |
Copyright Holders: | Copyright © 2018 The Authors |
First Published: | First published in Surgical Endoscopy 33(1): 110-121 |
Publisher Policy: | Reproduced under a Creative Commons License |
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