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A RETROSPECTIVE AND PROSPECTIVE STUDY TO DEVELOP A PRE-OPERATIVE TECHNICAL DIFFICULTY SCORE DURING LAPAROSCOPIC CHOLECYSTECTOMY
Yousef Ibrahim^*, Rami Radwan, Ali Adel Ne’ma Abdullah, Mohamed Sherif, Usman Khalid, James Ansell, Ashraf Rasheed
Royal Gwent Hospital, Newport, United Kingdom
Background: The objectives of this study were to develop a grading system to enable pre-operative prediction of technical difficulty of laparoscopic cholecystectomy using retrospective data and to attempt to validate our findings prospectively.
Methods: Retrospective Cohort: Analysis was conducted of 100 consecutive patients. Pre-operative variables were collected based on worksheet template devised by the American College of Surgeons. Multivariate analysis with subsequent measurement of hazard ratios were used to formulate a weighted grading system. Prospective Cohort: Analysis was performed of 100 consecutive patients. Patients were scored pre-operatively. Analysis was performed using correlation coefficient and student t-test. Duration of surgery was our primary outcome measure and was used as a surrogate marker of technical difficulty in both cohorts.
Results: Retrospective Data: The variables that caused a significant increase in duration were male gender (p=0.023), age (p=0.030), pre-operative ERCP (P=0.001) and body mass index (BMI) (p=<0.01). These variables were entered into a multivariate analysis and hazard ratios calculated. This allowed the design of a weighted scoring system.Prospective Data: Analysis revealed a weak positive correlation between our scoring system and duration of surgery (0.34).
Conclusion: Our retrospective work identified four pre-operative variables that predicted a longer duration of surgery. Preliminary results from our prospective study suggest a weak positive correlation between this scoring system and duration of surgery. These results would need to be validated in an adequately powered prospective multi-centre study.

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