Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

被引：93

作者：

Griffiths, Ewen A. ^{[1
,2
,13
]}

Hodson, James ^{[3
]}

Vohra, Ravi S. ^{[4
]}

Marriott, Paul ^{[5
,6
,11
]}

Katbeh, Tarek ^{[7
]}

Zino, Samer ^{[7
]}

Nassar, Ahmad H. M. ^{[7
]}

Vohra, Ravinder S. ^{[8
]}

Kirkham, Amanda J. ^{[9
]}

Pasquali, Sandro ^{[10
]}

Marriott, Paul ^{[5
,6
,11
]}

Johnstone, Marianne ^{[11
,57
]}

Spreadborough, Philip ^{[11
,107
]}

Alderson, Derek ^{[12
]}

Griffiths, Ewen A. ^{[1
,2
,13
]}

Fenwick, Stephen ^{[14
]}

Elmasry, Mohamed ^{[14
]}

Nunes, Quentin M. ^{[14
]}

Kennedy, David ^{[14
]}

Khan, Raja Basit ^{[15
]}

Khan, Muhammad A. S. ^{[15
]}

Magee, Conor J. ^{[16
]}

Jones, Steven M. ^{[16
]}

Mason, Denise ^{[16
]}

Parappally, Ciny P. ^{[16
]}

Mathur, Pawan ^{[17
]}

Saunders, Michael ^{[17
]}

Jamel, Sara ^{[17
]}

Haque, Samer Ul ^{[17
]}

Zafar, Sara ^{[17
]}

Shiwani, Muhammad Hanif ^{[18
]}

Samuel, Nehemiah ^{[18
]}

Dar, Farooq ^{[18
]}

Jackson, Andrew ^{[18
]}

Lovett, Bryony ^{[19
]}

Dindyal, Shiva ^{[19
]}

Winter, Hannah ^{[19
]}

Fletcher, Ted ^{[19
]}

Rahman, Saquib ^{[19
]}

Wheatley, Kevin ^{[20
]}

Nieto, Tom ^{[20
]}

Ayaani, Soofiyah ^{[20
]}

Youssef, Haney ^{[21
]}

Nijjar, Rajwinder S. ^{[21
]}

Watkin, Helen ^{[21
]}

Naumann, David ^{[21
]}

Emesih, Sophie ^{[21
]}

Sarmah, Piyush B. ^{[21
]}

Lee, Kathryn ^{[21
]}

Joji, Nikita ^{[21
]}

机构：

[1] Univ Hosp Birmingham NHS Fdn Trust, Dept Upper Gastrointestinal Surg, Birmingham, W Midlands, England

[2] Univ Birmingham, Inst Canc & Genom Sci, Coll Med & Dent Sci, Birmingham, W Midlands, England

[3] Univ Hosp Birmingham NHS Fdn Trust, Inst Translat Med, Birmingham, W Midlands, England

[4] Nottingham Univ Hosp NHS Trust, Trent Oesophagogastr Unit, Nottingham, England

[5] Univ Birmingham, Acad Dept Surg, West Midlands Res Collaborat, Birmingham, W Midlands, England

[6] Warwick Hosp, Dept Surg, Lakin Rd, Warwick, England

[7] Univ Hosp Monklands, Dept Surg, Airdrie, Lanark, Scotland

[8] Nottingham Univ Hosp NHS Fdn Trust, Nottingham Oesophagogastr Unit, Hucknall Rd, Nottingham, England

[9] Univ Birmingham, Canc Res UK Clin Trials Unit, Birmingham, W Midlands, England

[10] Veneto Inst Oncol IOV IRCCS, Surg Oncol Unit, Padua, Italy

[11] Univ Birmingham, Acad Dept Surg, West Midlands Res Collaborat, Birmingham, W Midlands, England

[12] Univ Birmingham, Acad Dept Surg, Surg, Birmingham, W Midlands, England

[13] Univ Hosp Birmingham NHS Fdn Trust, Dept Upper Gastrointestinal Surg, Birmingham, W Midlands, England

[14] Aintree Univ Hosp NHS Fdn Trust, Liverpool, Merseyside, England

[15] Airedale Dist Gen Hosp, Steeton, England

[16] Wirral Univ Teaching Hosp, Birkenhead, Merseyside, England

[17] Barnet & Chase Farm Hosp, London, England

[18] Barnsley Dist Gen Hosp, Barnsley, England

[19] Basildon Univ Hosp, Basildon, England

[20] Sandwell & West Birmingham Hosp NHS Trust, West Bromwich, England

[21] Heart England Fdn NHS Trust, Birmingham, W Midlands, England

[22] Blackpool Teaching Hosp NHS Fdn Trust, Blackpool, England

[23] Univ Hosp Bristol NHS Trust, Bristol, Avon, England

[24] Broomfield Hosp, Broomfield, England

[25] Calderdale & Huddersfield NHS Trust, Huddersfield, W Yorkshire, England

[26] Hull & East Yorkshire NHS Trust, Kingston Upon Hull, N Humberside, England

[27] Chesterfield Royal Hosp NHS Fdn Trust, Chesterfield, England

[28] Colchester Hosp Univ NHS Fdn Trust, Colchester, Essex, England

[29] Countess Chester NHS Fdn Trust, Chester, Cheshire, England

[30] Croydon Hlth Serv NHS Trust, Croydon, England

[31] North Cumbria Univ Hosp Trust, Carlisle, England

[32] Plymouth Hosp NHS Trust, Plymouth, Devon, England

[33] Mid Yorkshire NHS Trust, Wakefield, England

[34] Northern Lincolnshire & Goole NHS Fdn Trust, Scunthorpe, England

[35] Doncaster & Bassetlaw Hosp NHS Fdn Trust, Doncaster, England

[36] Dorset Cty Hosp NHS Fdn Trust, Dorchester, England

[37] North Bristol NHS Trust, Bristol, Avon, England

[38] Freeman Rd Hosp, Newcastle Upon Tyne, Tyne & Wear, England

[39] Frimley Pk Hosp NHS Trust, Frimley, England

[40] Gloucestershire Hosp NHS Trust, Cheltenham, Glos, England

[41] Great Western Hosp NHS Fdn Trust, Swindon, Wilts, England

[42] Harrogate & Dist NHS Fdn Trust, Harrogate, England

[43] Wye Valley NHS Trust, Hereford, England

[44] Homerton Univ Hosp NHS Trust, London, England

[45] Tees Hosp NHS Fdn Trust, Northallerton, England

[46] Paget Univ Hosp NHS Fdn Trust, Great Yarmouth, England

[47] Oxford Univ NHS Trust, Oxford, England

[48] Kettering Gen Hosp NHS Fdn Trust, Kettering, England

[49] Barking Havering & Redbridge Univ Hosp NHS Trust, Romford, Essex, England

[50] Kings Mill Hosp, Sutton In Ashfield, England

来源：

SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES | 2019年 / 33卷 / 01期

关键词：

Surgery; Laparoscopic; Cholecystectomy; Operative difficulty; Difficulty grading; INTRAOPERATIVE CHOLANGIOGRAPHY; CONVERSION; STONES;

D O I：

10.1007/s00464-018-6281-2

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

BackgroundA 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.MethodsPatient 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.ResultsA 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).ConclusionWe 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.

引用

页码：110 / 121

页数：12

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