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Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

Title:	Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy
Authors:	Ravinder S. Vohra; Amanda J. Kirkham; Sandro Pasquali; Paul Marriott; Marianne Johnstone; Philip Spreadborough; Derek Alderson; Ewen A. Griffiths; Stephen Fenwick; Mohamed Elmasry; Quentin M. Nunes; David Kennedy; Raja Basit Khan; Muhammad A. S. Khan; Conor J. Magee; Steven M. Jones; Denise Mason; Ciny P. Parappally; Pawan Mathur; Michael Saunders; Sara Jamel; Samer U. l. Haque; Sara Zafar; Muhammad Hanif Shiwani; Nehemiah Samuel; Farooq Dar; Andrew Jackson; Bryony Lovett; Shiva Dindyal; Hannah Winter; Ted Fletcher; Saquib Rahman; Kevin Wheatley; Tom Nieto; Soofiyah Ayaani; Haney Youssef; Rajwinder S. Nijjar; Helen Watkin; David Naumann; Sophie Emesih; Piyush B. Sarmah; Kathryn Lee; Nikita Joji; Joel Lambert; Jonathan Heath; Rebecca L. Teasdale; Chamindri Weerasinghe; Paul J. Needham; Hannah Welbourn; Luke Forster; David Finch; Jane M. Blazeby; William Robb; Angus G. K. McNair; Alex Hrycaiczuk; Alexandros Charalabopoulos; Sritharan Kadirkamanathan; Cheuk-Bong Tang; Naga V. G. Jayanthi; Nigel Noor; Brian Dobbins; Andrew J. Cockbain; April Nilsen-Nunn; Jonathan de Siqueira; Mike Pellen; Jonathan B. Cowley; Wei-Min Ho; Victor Miu; Timothy J. White; Kathryn A. Hodgkins; Alison Kinghorn; Matthew G. Tutton; Yahya A. Al-Abed; Donald Menzies; Anwar Ahmad; Joanna Reed; Shabuddin Khan; David Monk; Louis J. Vitone; Ghulam Murtaza; Abraham Joel; Stephen Brennan; David Shier; Catherine Zhang; Thusidaran Yoganathan; Steven J. Robinson; Iain J. D. McCallum; Michael J. Jones; Mohammed Elsayed; Liz Tuck; John Wayman; Kate Carney; Somaiah Aroori; Kenneth B. Hosie; Adam Kimble; David M. Bunting; Adeshina S. Fawole; Mohammed Basheer; Rajiv V. Dave; Janahan Sarveswaran; Elinor Jones; Chris Kendal; Michael P. Tilston; Martin Gough; Tom Wallace; Shailendra Singh; Justine Downing Katherine A. Mockford; Eyad Issa; Nayab Shah; Neal Chauhan; Timothy R. Wilson; Amir Forouzanfar; Jonathan R. L. Wild; Emma Nofal; Catherine Bunnell; Khaliel Madbak; Sudhindra T. V. Rao; Laurence Devoto; Najaf Siddiqi; Zechan Khawaja; James C. Hewes; Laura Gould; Alice Chambers; Daniel Urriza Rodriguez; Gourab Sen; Stuart Robinson; Francis Bartlett; David M. Rae; Thomas E. J. Stevenson; Kas Sarvananthan; Simon J. Dwerryhouse; Simon M. Higgs; Oliver J. Old; Thomas J. Hardy; Reena Shah Steve T. Hornby; Ken Keogh; Lucinda Frank; Musallam Al-Akash; Emma A. Upchurch; Richard J. Frame; Michael Hughes; Clare Jelley; Simon Weaver; Sudipta Roy; Toritseju O. Sillo; Giorgios Galanopoulos; Tamzin Cuming; Pedro Cunha; Salim Tayeh; Sarantos Kaptanis; Mohamed Heshaishi; Abdalla Eisawi; Michael Abayomi; Wee Sing Ngu; Katie Fleming; Dalvir S. Bajwa; Vivek Chitre; Kamal Aryal; Paul Ferris; Michael Silva; Simon Lammy Sarah Mohamed; Amir Khawaja; Adnan Hussain; Mudassar A Ghazanfar; Maria Irene Bellini; Hamdi Ebdewi; Mohamed Elshaer; Gianpiero Gravante; Benjamin Drake; Arikoge Ogedegbe; Dipankar Mukherjee; Chanpreet Arhi; Lola Giwa Nusrat Iqbal; Nicholas F Watson; Smeer Kumar Aggarwal; Philippa Orchard; Eduardo Villatoro; Peter D. Willson; Kam Wa Jessica Mok; Thomas Woodman; Jean Deguara; Giuseppe Garcea; Benoy I Babu; AR Dennison; Deep Malde; David Lloyd; Steve Satheesan; Omer Al-Taan; Alexander Boddy; John P. Slavin; Robert P. Jones; Laura Balance; Stratos Gerakopoulos; Periyathambi Jambulingam; Sami Mansour; Naomi Sakai; Vikas Acharya; Mohammed M. Sadat; Lawen Karim; David Larkin; Khalid Amin; Amarah Khan; Jennifer Law; Saurabh Jamdar; Stella R. Smith; Keerthika Sampat; Kathryn M. O'shea; Mangta Manu; Fotini M. Asprou; Nabeela S. Malik; Jessica Chang; Michael Lewis; Geoffrey P. Roberts; Babu Karavadra; Evangelos Photi; James Hewes; Dan Rodriguez; Derek A O'Reilly; Anthony J. Rate; Hema Sekhar; Lucy T. Henderson; Benjamin Z. Starmer; Peter O. Coe; Sotonye Tolofari; Jenifer Barrie; Gareth Bashir; Jake Sloane; Suroosh Madanipour; Constantine Halkias; Alexander E. J. Trevatt; David W. Borowski; Jane Hornsby; Michael J. Courtney; Suvi Virupaksha; Keith Seymour; Sarah Robinson; Helen Hawkins; Sadiq Bawa; Paul V. Gallagher; Alistair Reid; Peter Wood; J. G. Finch; J. Guy Finch; J. Parmar; E. Stirland; James Gardner-Thorpe; Ahmed Al-Muhktar; Mark Peterson; Ali Majeed; Farrukh M. Bajwa; Jack Martin; Alfred Choy; Andrew Tsang; Naresh Pore; David R. Andrew; Waleed Al-Khyatt; Christopher Taylor Santosh Bhandari; Adam Chambers; Dhivya Subramanium; Simon K. C. Toh; Nicholas C. Carter; Sophie Tate; Belinda Pearce; Denise Wainwright; Stuart J. Mercer; Benjamin Knight; Vardhini Vijay; Swethan Alagaratnam; Sidhartha Sinha; Shahab Khan; Shamsi S. El-Hasani; Abdulzahra A. Hussain; Vish Bhattacharya; Nisheeth Kansal; Tani Fasih; Claire Jackson; Midhat N. Siddiqui; Imran A. Chishti; Imogen J. Fordham; Zohaib Siddiqui; Harald Bausbacher; Ileana Geogloma; Kabita Gurung; George Tsavellas; Pradeep Basynat; Ashish Kiran Shrestha; Sanjoy Basu; Alok Chhabra Mohan Harilingam; Mohamed Rabie; Mansoor Akhtar; Pradeep Kumar; Sadaf F. Jafferbhoy; Najam Hussain; Soulat Raza; Manzarul Haque; Imran Alam; Rabiya Aseem; Shakira Patel; Mehek Asad; Michael I. Booth; William R. Ball; Christopher P. J. Wood; Ana C. Pinho-Gomes; Ambareen Kausar; Moh'd Rami Obeidallah; Joseph Varghase; Joshil Lodhia; Donal Bradley; Carla Rengifo; David Lindsay; Sivakumar Gopalswamy; Ian Finlay; Stacy Wardle; Naomi Bullen; Syed Yusuf Iftikhar; Altaf Awan; Javed Ahmed; Paul Leeder; Guiseppe Fusai; Giles Bond-Smith; Alicja Psica; Yogesh Puri; David Hou; Fergus Noble; Karoly Szentpali; Jack Broadhurst; Ravindra Date; Martin R. Hossack; Yan Li Goh; Paul Turner; Vinutha Shetty; Manel Riera; Christina A. W. Macano; Anisha Sukha; Shaun R. Preston; Jennifer R. Hoban; Daniel J. Puntis; Sophie V. Williams; Richard Krysztopik; James Kynaston; Jeremy Batt; Matthew Doe; Andrzej Goscimski; Gareth H. Jones; Claire Hall; Nick Carty; Jamil Ahmed; Sofoklis Panteleimonitis; Rohan T. Gunasekera; Andrea R. G. Sheel; Hannah Lennon; Caroline Hindley; Marcus Reddy; Ross Kenny; Natalie Elkheir; Emma R. McGlone; Rajasundaram Rajaganeshan; Kate Hancorn; Anita Hargreaves; Raj Prasad; David A. Longbotham; Dhakshinamoorthy Vijayanand; Imeshi Wijetunga; Paul Ziprin; Christopher R. Nicolay; Geoffrey Yeldham; Edward Read; James A. Gossage; Rachel C. Rolph; Husam Ebied; Manraj Phull; Mohammad A. Khan; Matthew Popplewell; Dimitrios Kyriakidis; Anwar Hussain; Natasha Henley; Jessica R. Packer; Laura Derbyshire; Jonathan Porter; Shaun Appleton; Marwan Farouk; Melvinder Basra; Neil A. Jennings; Shahda Ali; Venkatesh Kanakala; Haythem Ali; Risha Lane; Richard Dickson-Lowe; Prizzi Zarsadias; Darius Mirza; Sonia Puig; Khalid Al Amari; Deepak Vijayan; Robert Sutcliffe; Ravi Marudanayagam; Zayed Hamady; Abheesh R. Prasad; Abhilasha Patel; Damien Durkin; Parminder Kaur; Laura Bowen; James P. Byrne; Katherine L. Pearson; Theo G. Delisle; James Davies; Mark A. Tomlinson; Michelle A. Johnpulle; Corinna Slawinski; Andrew Macdonald; James Nicholson; Katy Newton; James Mbuvi; Ansar Farooq; Bhavani Sidhartha Mothe; Zakhi Zafrani; Daniel Brett; James Francombe; James Barnes; Melanie Cheung; Ahmed Z. Al-Bahrani; Giuseppe Preziosi; Tomas Urbonas; Justin Alberts; Mekhlola Mallik; Krashna Patel; Ashvina Segaran; Triantafyllos Doulias; Pratik A. Sufi; Caroline Yao; Sarah Pollock; Antonio Manzelli; Saj Wajed; Michail Kourkulos; Roberto Pezzuto; Martin Wadley; Emma Hamilton; Shameen Jaunoo; Robert Padwick; Mazin Sayegh; Richard C. Newton; Madhusoodhana Hebbar; Sameh F. Farag; John Spearman; Mohammed F. Hamdan; Conrad D'Costa; Christine Blane; Mathew Giles; Mark B. Peter; Natalie A. Hirst; Tanvir Hossain; Arslan Pannu Yesar El-Dhuwaib; Tamsin E. M. Morrison; Greg W. Taylor; Ronald L. E. Thompson; Ken McCune; Paula Loughlin; Roger Lawther; Colman K. Byrnes; Duncan J. Simpson; Abi Mawhinney; Conor Warren; Damian McKay; Colin McIlmunn; Serena Martin; Matthew MacArtney; Tom Diamond; Phil Davey; Claire Jones; Joshua M. Clements; Ruairi Digney; Wei Ming Chan; Stephen McCain; Sadaf Gull; Adam Janeczko; Emmet Dorrian; Andrew Harris; Suzanne Dawson; Dorothy Johnston; Barry McAree; Essam Ghareeb; George Thomas; Martin Connelly; Stephen McKenzie; Krzysztos Cieplucha; Gary Spence; William Campbell; Gareth Hooks; Neil Bradley; Arnold D. K. Hill; John T. Cassidy; Michael Boland; Paul Burke; Deirdre M. Nally; Elmoataz Khogali; Wael Shabo; Edrin Iskandar; Gerry P. McEntee; Maeve A. O'Neill; Colin Peirce; Emma M. Lyons; Adrian W. O'Sullivan; Rohan Thakkar; Paul Carroll; Ivan Ivanovski; Paul Balfe; Matthew Lee; Des C. Winter; Michael E. Kelly; Emir Hoti; Donal Maguire; Priyadarssini Karunakaran; Justin G. Geoghegan; Frank McDermott; Sean T. Martin; Keith S. Cross; Fiachra Cooke; Saquib Zeeshan; James O. Murphy; Ken Mealy; Helen M. Mohan; Yuwaraja Nedujchelyn; Muhammad Fahad Ullah; Irfan Ahmed; Francesco Giovinazzo; James Milburn; Sarah Prince; Eleanor Brooke; Joanna Buchan; Ahmed M. Khalil; Elizabeth M. Vaughan; Michael I. Ramage; Roland C. Aldridge; Simon Gibson; Gary A. Nicholson; David G. Vass; Alan J. Grant; David J. Holroyd; M. Angharad Jones; Cherith M. L. R. Sutton; Patrick O'Dwyer; Frida Nilsson; Beatrix Weber; Tracey K. Williamson; Kushik Lalla; Alice Bryant; C. Ross Carter; Craig R. Forrest; David I. Hunter; Ahmad H. Nassar; Mavis N. Orizu; Katrina Knight; Haitham Qandeel; Stuart Suttie; Rowena Belding; Andrew McClarey; Alan T. Boyd; Graeme J. K. Guthrie; Pei J. Lim; Andreas Luhmann; Angus J. M. Watson; Colin H. Richards; Laura Nicol; Marta Madurska; Ewen Harrison; Kathryn M. Boyce; Amanda Roebuck; Graeme Ferguson; Pradeep Pati; Michael S. J. Wilson; Faith Dalgaty; Laura Fothergill; Peter J. Driscoll; Kirsty L. Mozolowski; Victoria Banwell; Stephen P. Bennett; Paul N. Rogers; Brendan L. Skelly; Claire L. Rutherford; Ahmed K. Mirza; Taha Lazim; Henry C. C. Lim; Diana Duke; Talat Ahmed; William D. Beasley; Marc D. Wilkinson; Geta Maharaj; Cathy Malcolm; Timothy H. Brown; Bilal Al-Sarireh; Guy M. Shingler; Nicholas Mowbray; Rami Radwan; Paul Morcous; Simon Wood; Abbas Kadhim; Duncan J. Stewart; Andrew L. Baker; Nicola Tanner; Hrishikesh Shenoy; Shazia Hafiz; Joshua A. De Marchi; Deepak Singh-Ranger; Elzanati Hisham; Paul Ainley; Stephen O'Neill John Terrace; Sara Napetti; Benjamin Hopwood; Thomas Rhys; Justine Downing; Osama Kanavati; Maria Coats; Danail Aleksandrov; Charlotte Kallaway; Salama Yahya; Alexa Templeton; Martin Trotter; Christina Lo; Ajit Dhillon; Nick Heywood; Yousif Aawsaj; Alhafidz Hamdan; Obuobi Reece-Bolton; Andrew McGuigan; Yousef Shahin; Aymon; Ali Alison Luther; James A Nicholson; Ilayaraja Rajendran; Matthew Boal; Judith Ritchie
Contributors:	Vohra, Ravinder S.; Kirkham, Amanda J.; Pasquali, Sandro; Marriott, Paul; Johnstone, Marianne; Spreadborough, Philip; Alderson, Derek; Griffiths, Ewen A.; Fenwick, Stephen; Elmasry, Mohamed; Nunes, Quentin M.; Kennedy, David; Basit Khan, Raja; Khan, Muhammad A. S.; Magee, Conor J.; Jones, Steven M.; Mason, Denise; Parappally, Ciny P.; Mathur, Pawan; Saunders, Michael; Jamel, Sara; Haque, Samer U. l.; Zafar, Sara; Hanif Shiwani, Muhammad; Samuel, Nehemiah; Dar, Farooq; Jackson, Andrew; Lovett, Bryony; Dindyal, Shiva; Winter, Hannah; Fletcher, Ted; Rahman, Saquib; Wheatley, Kevin; Nieto, Tom; Ayaani, Soofiyah; Youssef, Haney; Nijjar, Rajwinder S.; Watkin, Helen; Naumann, David; Emesih, Sophie; Sarmah, Piyush B.; Lee, Kathryn; Joji, Nikita; Lambert, Joel; Heath, Jonathan; Teasdale, Rebecca L.; Weerasinghe, Chamindri; Needham, Paul J.; Welbourn, Hannah; Forster, Luke; Finch, David; Blazeby, Jane M.; Robb, William; Mcnair, Angus G. K.; Hrycaiczuk, Alex; Charalabopoulos, Alexandro; Kadirkamanathan, Sritharan; Tang, Cheuk-Bong; Jayanthi, Naga V. G.; Noor, Nigel; Dobbins, Brian; Cockbain, Andrew J.; Nilsen-Nunn, April; de Siqueira, Jonathan; Pellen, Mike; Cowley, Jonathan B.; Ho, Wei-Min; Miu, Victor; White, Timothy J.; Hodgkins, Kathryn A.; Kinghorn, Alison; Tutton, Matthew G.; Al-Abed, Yahya A.; Menzies, Donald; Ahmad, Anwar; Reed, Joanna; Khan, Shabuddin; Monk, David; Vitone, Louis J.; Murtaza, Ghulam; Joel, Abraham; Brennan, Stephen; Shier, David; Zhang, Catherine; Yoganathan, Thusidaran; Robinson, Steven J.; Mccallum, Iain J. D.; Jones, Michael J.; Elsayed, Mohammed; Tuck, Liz; Wayman, John; Carney, Kate; Aroori, Somaiah; Hosie, Kenneth B.; Kimble, Adam; Bunting, David M.; Fawole, Adeshina S.; Basheer, Mohammed; Dave, Rajiv V.
Publisher Information:	Springer Science and Business Media, LLC; 233 SPRING ST, NEW YORK, NY 10013 USA
Publication Year:	2019
Collection:	Sapienza Università di Roma: CINECA IRIS
Subject Terms:	cholecystectomy; difficulty grading; laparoscopic; operative difficulty; surgery; adult; aged; conversion to open surgery; female; human; length of stay; male; middle aged; multivariate analysi; postoperative complication; prospective studie; ROC curve
Description:	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 ...
Document Type:	article in journal/newspaper
Language:	English
Relation:	info:eu-repo/semantics/altIdentifier/pmid/29956029; info:eu-repo/semantics/altIdentifier/wos/WOS:000456089200014; volume:33; issue:1; firstpage:110; lastpage:121; numberofpages:12; journal:SURGICAL ENDOSCOPY; https://hdl.handle.net/11573/1634714
DOI:	10.1007/s00464-018-6281-2
Availability:	https://hdl.handle.net/11573/1634714; https://doi.org/10.1007/s00464-018-6281-2
Rights:	info:eu-repo/semantics/openAccess
Accession Number:	edsbas.C72E2E67
Database:	BASE