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Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

机译：利用腹腔镜胆囊切除术的手术难度分级规模

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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 p0.001). 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 p0.001).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.
机译：Backgrounda腹腔镜胆囊切除术的分级操作难度的可靠系统将标准化结果的描述和结果的报告。本研究的目的是验证难度的分级系统（Nassar Scale），测试其在两个大型前瞻性数据集中的适用性和一致性。在两个前瞻性胆囊切除术数据库中确定了三分之二和疾病相关的变量和30天的结果：多 - 近期辣味研究8820名患者的中心预期队列和含有4089名患者的单外科医生系列。操作系统和患者结果与Nassar操作难度刻度相关，使用Kendall的Dichotomous变量，或jonckheere-terpstra用于连续变量的测试。进行ROC曲线分析，以量化每种结果的规模的预测精度，在分析之前，具有二分法的连续结果。结果更高的手术难度等级与患者在参考和鸡族队中的患者中的更糟糕的结果始终如一。中位数保持时间从0到4天增加，30天的并发症率从7.6到24.4％，因为难度等级从1到4/5增加（P <0.001）增加。在Choles Cohort中，发现较高的难度等级与转化为开放和30天死亡率（Auroc = 0.903,0.822）的转化率最强烈相关。在多变量分析中，纳萨尔操作难度刻度被发现是术持续时间的显着独立预测因子，转化为开放手术，30天并发症和30天的重复（所有P <0.001）。CONCLUSEVEREWNSEDSEDSWE可以通过多个等级的外科医生来规范操作结果的描述，以促进审计，培训评估和研究。它为报告操作结果，疾病严重程度和技术难度提供了一种工具，并且可以在未来的研究中使用，以便根据案例组合和术语难度可靠地比较结果。

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