Validation of a western scoring system on large asian Series of outcomes following elective laparoscopic cholecystectomy; A value driven outcome based analysis

Abstract

Laparoscopic cholecystectomy is one of the most commonly performed general surgical procedures worldwide. We aim to validate an international scoring system (CLOC score), in predicting day surgery in a large tertiary Asian hospital. Subsequently, using a Value Driven Outcomes (VDO) based analysis of the results; we describe an algorithm of quality patient care.A retrospective study of a prospectively held database in a large tertiary hospital was undertaken between April 2015 and April 2017. All patients with complete data who underwent elective cholecystectomy in the study time frame were included. Each patient was assigned a CLOC score and divided into two groups - discharged within 24hrs and more than 24hrsOver 1000 patients underwent laparoscopic cholecystectomy with 619 included in this study with complete data. The CLOC score was an independent predictor of length of stay less or more than 24 hours (score = 8.1 versus 9.3 respectively; p< 0.0001). An AUC on an ROC curve of the CLOC predicting day surgery was 0.7. At a cut off of CLOC=8 or more the sensitivity and specificity of this prediction was 67% and 60% respectively. Using a cut off 8, we noted a significant difference in cost of care. Using a score previously validated in a western population to predict conversion to open cholecystectomy, we describe in this retrospective analysis, its use in predicting day surgery. An interplay of logistic regression and VDO analysis has resulted in a management algorithm that will help streamline care in this common general surgical procedure.