1. Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy
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Griffiths, Ewen A, Hodson, James, Vohra, Ravi S, Marriott, Paul, Katbeh, Tarek, Zino, Samer, Nassar, Ahmad HM, Vohra, Ravinder S, Kirkham, Amanda J, Pasquali, Sandro, Johnstone, Marianne, Spreadborough, Philip, Alderson, Derek, Fenwick, Stephen, Elmasry, Mohamed, Nunes, Quentin M, Kennedy, David, Khan, Raja Basit, Khan, Muhammad AS, Magee, Conor J, Jones, Steven M, Mason, Denise, Parappally, Ciny P, Mathur, Pawan, Saunders, Michael, Jamel, Sara, Haque, Samer Ul, Zafar, Sara, Shiwani, Muhammad Hanif, 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 GK, Hrycaiczuk, Alex, Charalabopoulos, Alexandros, Kadirkamanathan, Sritharan, Tang, Cheuk-Bong, Jayanthi, Naga VG, 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 JD, 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, Sarveswaran, Janahan, Jones, Elinor, Kendal, Chris, Tilston, Michael P, Gough, Martin, Wallace, Tom, Singh, Shailendra, Downing, Justine, Mockford, Katherine A, Issa, Eyad, Shah, Nayab, Chauhan, Neal, Wilson, Timothy R, Forouzanfar, Amir, Wild, Jonathan RL, Nofal, Emma, Bunnell, Catherine, Madbak, Khaliel, Rao, Sudhindra TV, Devoto, Laurence, Siddiqi, Najaf, Khawaja, Zechan, Hewes, James C, Gould, Laura, Chambers, Alice, Rodriguez, Daniel Urriza, Sen, Gourab, Robinson, Stuart, Bartlett, Francis, Rae, David M, Stevenson, Thomas EJ, Sarvananthan, Kas, Dwerryhouse, Simon J, Higgs, Simon M, Old, Oliver J, Hardy, Thomas J, Shah, Reena, Hornby, Steve T, Keogh, Ken, Frank, Lucinda, Al-Akash, Musallam, Upchurch, Emma A, Frame, Richard J, Hughes, Michael, Jelley, Clare, Weaver, Simon, Roy, Sudipta, Sillo, Toritseju O, Galanopoulos, Giorgios, Cuming, Tamzin, Cunha, Pedro, Tayeh, Salim, Kaptanis, Sarantos, Heshaishi, Mohamed, Eisawi, Abdalla, Abayomi, Michael, Ngu, Wee Sing, Fleming, Katie, Bajwa, Dalvi S, Chitre, Vivek, Aryal, Kamal, Ferris, Paul, Silva, Michael, Lammy, Simon, Mohamed, Sarah, Khawaja, Amir, Hussain, Adnan, Ghazanfar, Mudassar A, Bellini, Maria Irene, Ebdewi, Hamdi, Elshaer, Mohamed, Gravante, Gianpiero, Drake, Benjamin, Ogedegbe, Arikoge, Mukherjee, Dipankar, Arhi, Chanpreet, Giwa, Lola, Iqbal, Nusrat, Watson, Nicholas F, Aggarwal, Smeer Kumar, Orchard, Philippa, Villatoro, Eduardo, Willson, Peter D, Mok, Kam Wa Jessica, Woodman, Thomas, Deguara, Jean, Garcea, Giuseppe, Babu, Benoy I, Dennison, AR, Malde, Deep, Lloyd, David, Satheesan, Steve, Al-Taan, Omer, Boddy, Alexander, Slavin, John P, Jones, Robert P, Ballance, Laura, Gerakopoulos, Stratos, Jambulingam, Periyathambi, Mansour, Sami, Sakai, Naomi, Acharya, Vikas, Sadat, Mohammed M, Karim, Lawen, Larkin, David, Amin, Khalid, Khan, Amarah, Law, Jennifer, Jamdar, Saurabh, Smith, Stella R, Sampat, Keerthika, O'shea, Kathryn M, Manu, Mangta, Asprou, Fotini M, Malik, Nabeela S, Chang, Jessica, Lewis, Michael, Roberts, Geoffrey P, Karavadra, Babu, Photi, Evangelos, Hewes, James, Rodriguez, Dan, O'Reilly, Derek A, Rate, Anthony J, Sekhar, Hema, Henderson, Lucy T, Starmer, Benjamin Z, Coe, Peter O, Tolofari, Sotonye, Barrie, Jenifer, Bashir, Gareth, Sloane, Jake, Madanipour, Suroosh, Halkias, Constantine, Trevatt, Alexander EJ, Borowski, David W, Hornsby, Jane, Courtney, Michael J, Virupaksha, Suvi, Seymour, Keith, Robinson, Sarah, Hawkins, Helen, Bawa, Sadiq, Gallagher, Paul V, Reid, Alistair, Wood, Peter, Finch, JG, Finch, J Guy, Parmar, J, Stirland, E, Gardner-Thorpe, James, Al-Muhktar, Ahmed, Peterson, Mark, Majeed, Ali, Bajwa, Farrukh M, Martin, Jack, Choy, Alfred, Tsang, Andrew, Pore, Naresh, Andrew, David R, Al-Khyatt, Waleed, Bhandari, Christopher Taylor Santosh, Chambers, Adam, Subramanium, Dhivya, Toh, Simon KC, Carter, Nicholas C, Tate, Sophie, Pearce, Belinda, Wainwright, Denise, Mercer, Stuart J, Knight, Benjamin, Vijay, Vardhini, Alagaratnam, Swethan, Sinha, Sidhartha, Khan, Shahab, El-Hasani, Shamsi S, Hussain, Abdulzahra A, Bhattacharya, Vish, Kansal, Nisheeth, Fasih, Tani, Jackson, Claire, Siddiqui, Midhat N, Chishti, Imran A, Fordham, Imogen J, Siddiqui, Zohaib, Bausbacher, Harald, Geogloma, Ileana, Gurung, Kabita, Tsavellas, George, Basynat, Pradeep, Shrestha, Ashish Kiran, Basu, Sanjoy, Harilingam, Alok Chhabra Mohan, Rabie, Mohamed, Akhtar, Mansoor, Kumar, Pradeep, Jafferbhoy, Sadaf F, Hussain, Najam, Raza, Soulat, Haque, Manzarul, Alam, Imran, Aseem, Rabiya, Patel, Shakira, Asad, Mehek, Booth, Michael I, Ball, William R, Wood, Christopher PJ, Pinho-Gomes, Ana C, Kausar, Ambareen, Obeidallah, Moh'd Rami, Varghase, Joseph, Lodhia, Joshil, Bradley, Donal, Rengifo, Carla, Lindsay, David, Gopalswamy, Sivakumar, Finlay, Ian, Wardle, Stacy, Bullen, Naomi, Iftikhar, Syed Yusuf, Awan, Altaf, Ahmed, Javed, Leeder, Paul, Fusai, Guiseppe, Bond-Smith, Giles, Psica, Alicja, Puri, Yogesh, Hou, David, Noble, Fergus, Szentpali, Karoly, Broadhurst, Jack, Date, Ravindra, Hossack, Martin R, Goh, Yan Li, Turner, Paul, Shetty, Vinutha, Riera, Manel, Macano, Christina AW, Sukha, Anisha, Preston, Shaun R, Hoban, Jennifer R, Puntis, Daniel J, Williams, Sophie V, Krysztopik, Richard, Kynaston, James, Batt, Jeremy, Doe, Matthew, Goscimski, Andrzej, Jones, Gareth H, Hall, Claire, Carty, Nick, Ahmed, Jamil, Panteleimonitis, Sofoklis, Gunasekera, Rohan T, Sheel, Andrea RG, Lennon, Hannah, Hindley, Caroline, Reddy, Marcus, Kenny, Ross, Elkheir, Natalie, McGlone, Emma R, Rajaganeshan, Rajasundaram, Hancorn, Kate, Hargreaves, Anita, Prasad, Raj, Longbotham, David A, Vijayanand, Dhakshinamoorthy, Wijetunga, Imeshi, Ziprin, Paul, Nicolay, Christopher R, Yeldham, Geoffrey, Read, Edward, Gossage, James A, Rolph, Rachel C, Ebied, Husam, Phull, Manraj, Khan, Mohammad A, Popplewell, Matthew, Kyriakidis, Dimitrios, Hussain, Anwar, Henley, Natasha, Packer, Jessica R, Derbyshire, Laura, Porter, Jonathan, Appleton, Shaun, Farouk, Marwan, Basra, Melvinder, Jennings, Neil A, Ali, Shahda, Kanakala, Venkatesh, Ali, Haythem, Lane, Risha, Dickson-Lowe, Richard, Zarsadias, Prizzi, Mirza, Darius, Puig, Sonia, Al Amari, Khalid, Vijayan, Deepak, Sutcliffe, Robert, Marudanayagam, Ravi, Hamady, Zayed, Prasad, Abheesh R, Patel, Abhilasha, Durkin, Damien, Kaur, Parminder, Bowen, Laura, Byrne, James P, Pearson, Katherine L, Delisle, Theo G, Davies, James, Tomlinson, Mark A, Johnpulle, Michelle A, Slawinski, Corinna, Macdonald, Andrew, Nicholson, James, Newton, Katy, Mbuvi, James, Farooq, Ansar, Mothe, Bhavani Sidhartha, Zafrani, Zakhi, Brett, Daniel, Francombe, James, Barnes, James, Cheung, Melanie, Al-Bahrani, Ahmed Z, Preziosi, Giuseppe, Urbonas, Tomas, Alberts, Justin, Mallik, Mekhlola, Patel, Krashna, Segaran, Ashvina, Doulias, Triantafyllos, Sufi, Pratik A, Yao, Caroline, Pollock, Sarah, Manzelli, Antonio, Wajed, Saj, Kourkulos, Michail, Pezzuto, Roberto, Wadley, Martin, Hamilton, Emma, Jaunoo, Shameen, Padwick, Robert, Sayegh, Mazin, Newton, Richard C, Hebbar, Madhusoodhana, Farag, Sameh F, Spearman, John, Hamdan, Mohammed F, D'Costa, Conrad, Blane, Christine, Giles, Mathew, Peter, Mark B, Hirst, Natalie A, Hossain, Tanvir, El-Dhuwaib, Arslan Pannu Yesar, Morrison, Tamsin EM, Taylor, Greg W, Thompson, Ronald LE, McCune, Ken, Loughlin, Paula, Lawther, Roger, Byrnes, Colman K, Simpson, Duncan J, Mawhinney, Abi, Warren, Conor, McKay, Damian, McIlmunn, Colin, Martin, Serena, MacArtney, Matthew, Diamond, Tom, Davey, Phil, Jones, Claire, Clements, Joshua M, Digney, Ruairi, Chan, Wei Ming, McCain, Stephen, Gull, Sadaf, Janeczko, Adam, Dorrian, Emmet, Harris, Andrew, Dawson, Suzanne, Johnston, Dorothy, McAree, Barry, Ghareeb, Essam, Thomas, George, Connelly, Martin, McKenzie, Stephen, Cieplucha, Krzysztos, Spence, Gary, Campbell, William, Hooks, Gareth, Bradley, Neil, Hill, Arnold DK, Cassidy, John T, Boland, Michael, Burke, Paul, Nally, Deirdre M, Khogali, Elmoataz, Shabo, Wael, Iskandar, Edrin, McEntee, Gerry P, O'Neill, Maeve A, Peirce, Colin, Lyons, Emma M, O'Sullivan, Adrian W, Thakkar, Rohan, Carroll, Paul, Ivanovski, Ivan, Balfe, Paul, Lee, Matthew, Winter, Des C, Kelly, Michael E, Hoti, Emir, Maguire, Donal, Karunakaran, Priyadarssini, Geoghegan, Justin G, McDermott, Frank, Martin, Sean T, Cross, Keith S, Cooke, Fiachra, Zeeshan, Saquib, Murphy, James O, Mealy, Ken, Mohan, Helen M, Nedujchelyn, Yuwaraja, Ullah, Muhammad Fahad, Ahmed, Irfan, Giovinazzo, Francesco, Milburn, James, Prince, Sarah, Brooke, Eleanor, Buchan, Joanna, Khalil, Ahmed M, Vaughan, Elizabeth M, Ramage, Michael I, Aldridge, Roland C, Gibson, Simon, Nicholson, Gary A, Vass, David G, Grant, Alan J, Holroyd, David J, Jones, M Angharad, Sutton, Cherith MLR, O'Dwyer, Patrick, Nilsson, Frida, Weber, Beatrix, Williamson, Tracey K, Lalla, Kushik, Bryant, Alice, Carter, C Ross, Forrest, Craig R, Hunter, David I, Nassar, Ahmad H, Orizu, Mavis N, Knight, Katrina, Qandeel, Haitham, Suttie, Stuart, Belding, Rowena, McClarey, Andrew, Boyd, Alan T, Guthrie, Graeme JK, Lim, Pei J, Luhmann, Andreas, Watson, Angus JM, Richards, Colin H, Nicol, Laura, Madurska, Marta, Harrison, Ewen, Boyce, Kathryn M, Roebuck, Amanda, Ferguson, Graeme, Pati, Pradeep, Wilson, Michael SJ, Dalgaty, Faith, Fothergill, Laura, Driscoll, Peter J, Mozolowski, Kirsty L, Banwell, Victoria, Bennett, Stephen P, Rogers, Paul N, Skelly, Brendan L, Rutherford, Claire L, Mirza, Ahmed K, Lazim, Taha, Lim, Henry CC, Duke, Diana, Ahmed, Talat, Beasley, William D, Wilkinson, Marc D, Maharaj, Geta, Malcolm, Cathy, Brown, Timothy H, Al-Sarireh, Bilal, Shingler, Guy M, Mowbray, Nicholas, Radwan, Rami, Morcous, Paul, Wood, Simon, Kadhim, Abbas, Stewart, Duncan J, Baker, Andrew L, Tanner, Nicola, Shenoy, Hrishikesh, Hafiz, Shazia, De Marchi, Joshua A, Singh-Ranger, Deepak, Hisham, Elzanati, Ainley, Paul, O'Neill, Stephen, Terrace, John, Napetti, Sara, Hopwood, Benjamin, Rhys, Thomas, Kanavati, Osama, Coats, Maria, Aleksandrov, Danail, Kallaway, Charlotte, Yahya, Salama, Templeton, Alexa, Trotter, Martin, Lo, Christina, Dhillon, Ajit, Heywood, Nick, Aawsaj, Yousif, Hamdan, Alhafidz, Reece-Bolton, Obuobi, McGuigan, Andrew, Shahin, Yousef, Aymon, Luther, Ali Alison, Nicholson, James A, Rajendran, Ilayaraja, Boal, Matthew, Ritchie, Judith, Grp, CholeS Study, Collaborative, West Midlands Res, Segaran, A, and Collaborative, West Midlands Research
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medicine.medical_specialty ,medicine.medical_treatment ,030230 surgery ,Article ,03 medical and health sciences ,0302 clinical medicine ,Case mix index ,Laparoscopic ,length of stay ,male ,middle aged ,postoperative complications ,Medicine ,Cholecystectomy ,Prospective cohort study ,Grading (education) ,humans ,Laparoscopic cholecystectomy ,business.industry ,General surgery ,adult ,cholecystectomy ,difficulty grading ,laparoscopic ,operative difficulty ,surgery ,aged ,cholecystectomy, laparoscopic ,conversion to open surgery ,female ,multivariate analysis ,prospective studies ,ROC curve ,Difficulty grading ,Cohort ,030211 gastroenterology & hepatology ,Surgery ,business ,Operative difficulty ,Grading scale ,Abdominal surgery - Abstract
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 p 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 according to case mix and intra-operative difficulty.
- Published
- 2018