title: Clinical, Anatomical, and Pathological Grading Score to Predict Technical Difficulty in Laparoscopic Splenectomy for Non-traumatic Diseases.
abstract: We aimed to develop a grading system based on preoperative parameters that would predict surgical difficulty and morbidity in elective laparoscopic splenectomy.
  
  
  
  We retrospectively assessed morbidity in 439 patients who underwent laparoscopic splenectomy for benign and malignant disorders between 1993 and 2013. Medical and surgical records were reviewed and analyzed. We compared preoperative data concerning demographic, clinical, pathological, anatomical, laboratory, and radiological factors with three surgical outcomes: operative time, intraoperative bleeding, and surgical conversion. Univariate and multivariate analyses were performed to identify statistically significant variables. A logistic regression model was used to identify determinant variables and to compose a predictive score. External validation of the score was performed using an independent cohort of 353 patients.
  
  
  
  Four preoperative parameters (age, male sex, type of pathology, and spleen size based on final spleen weight) were significantly related with operative time, operative bleeding, and conversion to open surgery. Using these results, we developed a classification system with three levels of difficulty: low (≤4 points), medium (4.5-5.5 points), and high (≥6 points), based on the four preoperative parameters. The correlation was highly significant (p = <0.001) according to Spearman's correlation. The area under the ROC curve was 0.671 (95 % CI 0.596-0.745). The external validation showed significant correlations with the present model.
  
  
  
  The grading score described here is simple to calculate from the physical examination, laboratory tests, and US or CT images, and we believe it could be useful to preoperatively assess the technical complexity of laparoscopic splenectomy.
authors.affiliation: Departament of General and Digestive Surgery, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain. crodriguezlu@santpau.cat.
authors.forename: Carlos
authors.initials: C
authors.lastname: Rodriguez-Otero Luppi
authors.affiliation: Departament of General and Digestive Surgery, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: Eduardo M
authors.initials: EM
authors.lastname: Targarona Soler
authors.affiliation: Departament of General and Digestive Surgery, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Balague Ponz
authors.affiliation: Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
authors.forename: Juan Pablo
authors.initials: JP
authors.lastname: Pantoja Millán
authors.affiliation: Departament of General and Digestive Surgery, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: Victor
authors.initials: V
authors.lastname: Turrado Rodriguez
authors.affiliation: Departament of General and Digestive Surgery, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Pallares Segura
authors.affiliation: Departament of General and Digestive Surgery, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: Jesus
authors.initials: J
authors.lastname: Bollo Rodriguez
authors.affiliation: Departament of General and Digestive Surgery, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: Manel
authors.initials: M
authors.lastname: Trias Folch
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D061887:Conversion to Open Surgery; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D009929:Organ Size; D011183:Postoperative Complications; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013154:Spleen / Q000473:pathology; D013156:Splenectomy / Q000009:adverse effects*; D055815:Young Adult