Value of difficulty scoring system in predicting perioperative safety of laparoscopic splenectomy

Abstract

Objective To evaluate the difficulty scoring system for laparoscopic splenectomy (LS) in predicting the intraoperative adverse events and postoperative complications. Methods Clinical data of 202 patients with non-traumatic diseases who underwent LS in the First Affiliated Hospital of Xi'an Jiaotong University from January 2009 to December 2015 were retrospectively analyzed. Among them, 97 cases were male and 105 female, aged from 12 to 75 years old with a median age of 46. The informed consents of all patients were obtained and the local ethical committee approval was received. According to the difficulty scoring system for LS, all the patients were divided into the low-difficulty group (n=64), medium-difficulty group (n=54) and high-difficulty group (n=84). Intraoperative adverse events and postoperative complications were observed. The rate comparison was performed by Chi-square test or Fisher exact probability. The correlation between difficulty score and intraoperative adverse events, postoperative complications was assessed by Spearman correlation coefficient. The prediction efficiency was evaluated by receiver operating characteristic (ROC) curve. Results The difficulty scoring system was significantly correlated with the operation time, intraoperative blood loss and postoperative complications (χ2=11.517, 6.521, 22.526; P 0.05). The difficulty scoring system was significantly positively correlated with the operation time and incidence of postoperative complications (rs= 0.273, 0.324; P 0.05). The area under ROC curve of difficulty scoring system for predicting the intraoperative adverse events was 0.593 (95% CI: 0.513-0.673). Conclusions Difficulty scoring system for LS cannot accurately predict the incidence of intraoperative adverse events and postoperative complications of LS in China. It is necessary to establish a difficulty scoring system for LS suitable for the Chinese population. Key words: Splenectomy; Laparoscopes; Postoperative complications