Predicting major complications after laparoscopic cholecystectomy: a simple risk score.
BACKGROUND
Reported morbidity varies widely for laparoscopic cholecystectomy (LC). A reliable method to determine complication risk may be useful to optimize care. We developed an integer-based risk score to determine the likelihood of major complications following LC.


METHODS
Using the Nationwide Inpatient Sample 1998-2006, patient discharges for LC were identified. Using previously validated methods, major complications were assessed. Preoperative covariates including patient demographics, disease characteristics, and hospital factors were used in logistic regression/bootstrap analyses to generate an integer score predicting postoperative complication rates. A randomly selected 80% was used to create the risk score, with validation in the remaining 20%.


RESULTS
Patient discharges (561,923) were identified with an overall complication rate of 6.5%. Predictive characteristics included: age, sex, Charlson comorbidity score, biliary tract inflammation, hospital teaching status, and admission type. Integer values were assigned and used to calculate an additive score. Three groups stratifying risk were assembled, with a fourfold gradient for complications ranging from 3.2% to 13.5%. The score discriminated well in both derivation and validation sets (c-statistic of 0.7).


CONCLUSIONS
An integer-based risk score can be used to predict complications following LC and may assist in preoperative risk stratification and patient counseling.
Murphy
Melissa M
MM
Department of Surgery, UMass Surgical Outcomes Analysis & Research, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA.
Shah
Shimul A
SA
Simons
Jessica P
JP
Csikesz
Nicholas G
NG
McDade
Theodore P
TP
Bodnari
Andreea
A
Ng
Sing-Chau
SC
Zhou
Zheng
Z
Tseng
Jennifer F
JF
D000328:Adult; D000368:Aged; D000465:Algorithms; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D002769:Cholelithiasis / Q000453:epidemiology / Q000601:surgery; D015897:Comorbidity; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012372:ROC Curve; D018570:Risk Assessment