Preoperative Grading System Research Articles

Preoperative grading system for predicting operative conditions in laparoscopic cholecystectomy.

In a previous retrospective study, we predicted the operative conditions for abdominal wall-lifting laparoscopic cholecystectomy (ALLC), using a new preoperative grading system. We conducted the present study to evaluate the validity of our grading system prospectively, and to improve the operative outcome. Ninety-seven patients underwent cholecystectomy between January 2000 and March 2002, and were prospectively examined according to our preoperative grading system. Allotting 0-5 points for nine preoperative factors, the total combined score was defined as the predictive score. The postoperative score was defined by allotting 0-8 points to five operative factors. The ratio of the preoperative score / postoperative score was defined as the skill score. The mean postoperative score was significantly correlated with the predictive score (P < 0.01). The mean operation time and the mean postoperative score differed significantly among surgeons with skill scores higher or less than 1.25 (P < 0.05). They were significantly improved (P < 0.05) by choosing an operator according to the predictive score and skill score. Our preoperative grading system using the predictive score is a valid method of predicting the actual operative conditions of ALLC. An adequately skilled operator should be chosen according to the difficulty of each case, to ensure the best possible operative outcome.

A new preoperative grading system for predicting the operative conditions for abdominal wall-lifting laparoscopic cholecystectomy.

This study was performed to evaluate the operative conditions for an abdominal wall-lifting laparoscopic cholecystectomy (ALLC) using a new preoperative grading system. One hundred forty-five patients who underwent a cholecystectomy for cholecystolithiasis from January 1997 to December 1999 were retrospectively analyzed. Allotting 0-5 points for coexisting cholecystitis, past history, previous upper abdominal laparotomy, preoperative drainage, location of the stones, and body mass index, the total combined score was defined as the predictive score. The cases were graded into four risk groups according to the predictive score. The postoperative score, which evaluated the actual conditions of ALLC, was defined by allotting 0-8 points to operative factors: operation time, blood loss, additional trocars and procedures, conversion to open surgery, and postoperative complications. Ten cases (6.9%) were converted to open surgery and three cases (2.1%) had minor postoperative complications. The conversion rate for each risk group was 0% (minimum-risk group), 5.4% (low-risk group), 10.7% (intermediate-risk group), and 17.9% (high-risk group). The mean operation time was 63.0, 87.5, 89.0, and 120.2 min. The mean postoperative score was 1.08, 2.81, 3.96, and 6.36, and showed a respectively strong correlation with the predictive score (correlation coefficient: 0.997). Our preoperative grading system using the predictive score was found to be a reliable and feasible method for predicting the actual operative conditions for ALLC.