Defining prolonged length of stay following elective laparoscopic cholecystectomy and validation of a pre-operative risk score
EAES Academy. Lucocq J. 07/05/22; 363045; P089
Dr. James Lucocq
Contributions
Contributions
Abstract
Background:
Elective Laparoscopic cholecystectomy (ELLC) patients can suffer a prolonged length of stay (PLOS) secondary to several operation-related adverse outcomes. It is well recognised that PLOS following surgical procedures is associated with operation-related morbidity. Acknowledgement of the pre-operative risk factors for PLOS following ELLC will aid the risk-stratification process, the consent process and inform the feasibility of day-surgery.
Method
A cohort of 2166 ELLC were used to determine the relationship between PLOS and operation-related adverse outcomes. The optimal cut-off of PLOS as a predictor for operation-related adverse outcomes was found using receiver operating characteristic (ROC) curves and was defined as the cut off for PLOS. Multivariate logistic regression was conducted on a sub-cohort to derive a pre-operative model to predict PLOS. ROC curves were performed to validate the model. Patients were stratified by the risk tool and the risks of PLOS were determined.
Results
A length of stay of ≥3 days following ELLC demonstrated the best diagnostic ability for operation-related adverse outcomes (AUR=0.96) and was defined as the cut off for PLOS. The rate of PLOS was 6.6% (144/2166) and 100% (144/144) of PLOS patients had an operation-related adverse outcome. PLOS was strongly associated with all operative-related adverse outcomes including subtotal, conversion, intra-operative complications, drains, post-operative complication/imaging and intervention (p<0.001). The model demonstrated good diagnostic ability for PLOS in the derivation (AUC=0.81) and validation cohorts (AUC=0.76) and included the variables of age 40-60, age >60, ASA 2, ASA ≥3, ≥ 3 previous hospital admissions, cholecystitis, pre-operative ERCP and pre-operative cholecystostomy.
Discussion
Prolonged length of stay (≥3 days) is an important proxy for operation-related adverse outcomes. Although the rate of PLOS is low following ELLC, morbidity in these patients is significant and pragmatic patient selection in accordance with the risk tool will improve resource utilisation, risk-stratify patients and improve the consent process.
Elective Laparoscopic cholecystectomy (ELLC) patients can suffer a prolonged length of stay (PLOS) secondary to several operation-related adverse outcomes. It is well recognised that PLOS following surgical procedures is associated with operation-related morbidity. Acknowledgement of the pre-operative risk factors for PLOS following ELLC will aid the risk-stratification process, the consent process and inform the feasibility of day-surgery.
Method
A cohort of 2166 ELLC were used to determine the relationship between PLOS and operation-related adverse outcomes. The optimal cut-off of PLOS as a predictor for operation-related adverse outcomes was found using receiver operating characteristic (ROC) curves and was defined as the cut off for PLOS. Multivariate logistic regression was conducted on a sub-cohort to derive a pre-operative model to predict PLOS. ROC curves were performed to validate the model. Patients were stratified by the risk tool and the risks of PLOS were determined.
Results
A length of stay of ≥3 days following ELLC demonstrated the best diagnostic ability for operation-related adverse outcomes (AUR=0.96) and was defined as the cut off for PLOS. The rate of PLOS was 6.6% (144/2166) and 100% (144/144) of PLOS patients had an operation-related adverse outcome. PLOS was strongly associated with all operative-related adverse outcomes including subtotal, conversion, intra-operative complications, drains, post-operative complication/imaging and intervention (p<0.001). The model demonstrated good diagnostic ability for PLOS in the derivation (AUC=0.81) and validation cohorts (AUC=0.76) and included the variables of age 40-60, age >60, ASA 2, ASA ≥3, ≥ 3 previous hospital admissions, cholecystitis, pre-operative ERCP and pre-operative cholecystostomy.
Discussion
Prolonged length of stay (≥3 days) is an important proxy for operation-related adverse outcomes. Although the rate of PLOS is low following ELLC, morbidity in these patients is significant and pragmatic patient selection in accordance with the risk tool will improve resource utilisation, risk-stratify patients and improve the consent process.
Background:
Elective Laparoscopic cholecystectomy (ELLC) patients can suffer a prolonged length of stay (PLOS) secondary to several operation-related adverse outcomes. It is well recognised that PLOS following surgical procedures is associated with operation-related morbidity. Acknowledgement of the pre-operative risk factors for PLOS following ELLC will aid the risk-stratification process, the consent process and inform the feasibility of day-surgery.
Method
A cohort of 2166 ELLC were used to determine the relationship between PLOS and operation-related adverse outcomes. The optimal cut-off of PLOS as a predictor for operation-related adverse outcomes was found using receiver operating characteristic (ROC) curves and was defined as the cut off for PLOS. Multivariate logistic regression was conducted on a sub-cohort to derive a pre-operative model to predict PLOS. ROC curves were performed to validate the model. Patients were stratified by the risk tool and the risks of PLOS were determined.
Results
A length of stay of ≥3 days following ELLC demonstrated the best diagnostic ability for operation-related adverse outcomes (AUR=0.96) and was defined as the cut off for PLOS. The rate of PLOS was 6.6% (144/2166) and 100% (144/144) of PLOS patients had an operation-related adverse outcome. PLOS was strongly associated with all operative-related adverse outcomes including subtotal, conversion, intra-operative complications, drains, post-operative complication/imaging and intervention (p<0.001). The model demonstrated good diagnostic ability for PLOS in the derivation (AUC=0.81) and validation cohorts (AUC=0.76) and included the variables of age 40-60, age >60, ASA 2, ASA ≥3, ≥ 3 previous hospital admissions, cholecystitis, pre-operative ERCP and pre-operative cholecystostomy.
Discussion
Prolonged length of stay (≥3 days) is an important proxy for operation-related adverse outcomes. Although the rate of PLOS is low following ELLC, morbidity in these patients is significant and pragmatic patient selection in accordance with the risk tool will improve resource utilisation, risk-stratify patients and improve the consent process.
Elective Laparoscopic cholecystectomy (ELLC) patients can suffer a prolonged length of stay (PLOS) secondary to several operation-related adverse outcomes. It is well recognised that PLOS following surgical procedures is associated with operation-related morbidity. Acknowledgement of the pre-operative risk factors for PLOS following ELLC will aid the risk-stratification process, the consent process and inform the feasibility of day-surgery.
Method
A cohort of 2166 ELLC were used to determine the relationship between PLOS and operation-related adverse outcomes. The optimal cut-off of PLOS as a predictor for operation-related adverse outcomes was found using receiver operating characteristic (ROC) curves and was defined as the cut off for PLOS. Multivariate logistic regression was conducted on a sub-cohort to derive a pre-operative model to predict PLOS. ROC curves were performed to validate the model. Patients were stratified by the risk tool and the risks of PLOS were determined.
Results
A length of stay of ≥3 days following ELLC demonstrated the best diagnostic ability for operation-related adverse outcomes (AUR=0.96) and was defined as the cut off for PLOS. The rate of PLOS was 6.6% (144/2166) and 100% (144/144) of PLOS patients had an operation-related adverse outcome. PLOS was strongly associated with all operative-related adverse outcomes including subtotal, conversion, intra-operative complications, drains, post-operative complication/imaging and intervention (p<0.001). The model demonstrated good diagnostic ability for PLOS in the derivation (AUC=0.81) and validation cohorts (AUC=0.76) and included the variables of age 40-60, age >60, ASA 2, ASA ≥3, ≥ 3 previous hospital admissions, cholecystitis, pre-operative ERCP and pre-operative cholecystostomy.
Discussion
Prolonged length of stay (≥3 days) is an important proxy for operation-related adverse outcomes. Although the rate of PLOS is low following ELLC, morbidity in these patients is significant and pragmatic patient selection in accordance with the risk tool will improve resource utilisation, risk-stratify patients and improve the consent process.
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