UTILITY OF "ONOE SCORE" FOR SELECTION OF EMERGENT LAPAROSCOPIC CHOLECYSTECTOMY OPERATORS – A PROPENSITY-MATCHED ANALYSIS
Hayato Ohya*, Atsuyuki Maeda, Yuichi Takayama, Takamasa Takahashi
Surgery, Ogaki Shimin Byoin, Ogaki, Gifu, Japan
Background and Purpose
The critical view of safety (CVS) is an essential concept for safe emergent laparoscopic cholecystectomy (eLapC). In 2016, our institution proposed the preoperative "Onoe Score (OS)" to predict the ability to achieve CVS (Onoe S et al. HPB 2016). This scoring system includes three factors: CRP ≥5.5 mg/dL (2 points), gallstone impaction (1 point), and time duration from symptom onset to operation ≥72 hours (2 points). Since April 2021, we have used OS as a criteria for operator selection. Post-graduation year (PGY) 3–4 residents can perform only score 1 cases. If the score is 5, attending surgeons must perform the operation. We investigated the usefulness of OS in operator selection for eLapC.
Methods
Data from 571 patients who underwent eLapC for acute cholecystitis (AC) between January 2012 and October 2022 were collected retrospectively and divided into two groups: 436 patients before March 2021 (Before Onoe group: BO group) and 135 patients after April 2021 (After Onoe group: AO group). Clinical characteristics and surgical and postoperative outcomes were compared between groups. Propensity score matching was used to minimize selection bias. Patient propensity scores were calculated using all preoperative variables except the PGY of operators.
Results
Before matching (BO group vs. AO group), comparison of preoperative patient characteristics showed significant differences in age (64 vs. 70 years), anticoagulant therapy (8 vs. 20%), duration from onset to surgery (24 vs. 37 hours), ASA-PS≥3 (13 vs. 27%), CCI≥1 (34 vs. 56%). Preoperative blood tests showed significant differences in Cre (0.75 vs. 0.82), Alb (4.2 vs. 4.0) and PT-INR (1.04 vs. 1.06). Operator PGY distributions (PGY 3-4/5-9/10-) were 38%/53%/9% vs. 19%/71%/10%, respectively (p<0.001). In terms of surgical outcomes, there were significant differences in operative time (80 vs. 71 minutes), blood loss (10 vs. 20 ml), and CVS securement rate (80 vs. 70%). No significant differences were found in intraoperative injury rate (0.5 vs. 2.2%), open conversion rate (4.6 vs. 4.4%), and Clavien-Dindo≧3 postoperative complication rate (2.5 vs. 5.2%). After propensity score matching, 116 pairs were identified. Operator PGY distributions (PGY 3-4/5-9/10-) were 31%/57%/12% in the BO group vs. 20%/72%/8% in the AO group (p=0.049). Although blood loss, intraoperative injury rate, open conversion rate, and Clavien-Dindo≧3 postoperative complication rate did not significantly differ between groups, operative time (71 vs. 80 min: p=0.002) and postoperative hospital stay (3.3 vs. 3.9 days: p=0.003) were shorter in the AO group.
Conclusion
Utilizing OS for operator selection shortened operative time and hospital stay. Further data is needed to investigate the impacts on open conversion, intraoperative injuries, and postoperative complications.
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