title: Predicting major complications after laparoscopic cholecystectomy: a simple risk score.
abstract: 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.
authors: Department of Surgery, UMass Surgical Outcomes Analysis & Research, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA.
authors: Melissa M
authors: MM
authors: Murphy
authors: Shimul A
authors: SA
authors: Shah
authors: Jessica P
authors: JP
authors: Simons
authors: Nicholas G
authors: NG
authors: Csikesz
authors: Theodore P
authors: TP
authors: McDade
authors: Andreea
authors: A
authors: Bodnari
authors: Sing-Chau
authors: SC
authors: Ng
authors: Zheng
authors: Z
authors: Zhou
authors: Jennifer F
authors: JF
authors: Tseng
mesh_terms: 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