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Multicenter Study
. 2018 Jul;32(7):3149-3157.
doi: 10.1007/s00464-018-6030-6. Epub 2018 Jan 16.

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Reshma Bharamgoudar  1 , Aniket Sonsale  1 , James Hodson  2 , Ewen Griffiths  3   4 ; CholeS Study Group, West Midlands Research Collaborative
Collaborators, Affiliations
Multicenter Study

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Reshma Bharamgoudar et al. Surg Endosc. 2018 Jul.

Erratum in

Abstract

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations.

Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves.

Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45-85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p < 0.001), with the proportions of operations lasting > 90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score.

Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care.

Keywords: Laparoscopic cholecystectomy; Operative duration; Patient factors; Prediction; Scoring tool; Theatre utilisation.

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Conflict of interest statement

Miss Reshma Bharamgoudar, Mr Aniket Sonsale, Mr James Hodson and Mr Ewen Griffiths have no conflicts of interest or financial ties to disclose.

Figures

Fig. 1
Fig. 1
Demonstrates the relationship between the risk score and the proportion of operations taking > 90 min in the validation cohort. Of the 470 patients with risk scores of 0–3, only 5.1% (N = 24) of operations took > 90 min, increasing to 41.8% (109/261) in those with risk scores > 8
See this image and copyright information in PMC

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