College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK.
Institute of Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Surg Endosc. 2018 Jul;32(7):3149-3157. doi: 10.1007/s00464-018-6030-6. Epub 2018 Jan 16.
The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations.
Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves.
After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45-85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p < 0.001), with the proportions of operations lasting > 90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score.
The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care.
准确预测手术时间具有优化手术室效率和利用的潜力，从而降低成本，提高员工和患者满意度。由于腹腔镜胆囊切除术是全球最常见的手术之一，因此预测手术时间的工具对医疗机构可能非常有益。
使用 2014 年 4 月至 5 月期间在英国和爱尔兰医院接受胆囊切除术的 CholeS 研究的数据来研究手术时间。为了确定长（>90 分钟）手术的显著独立预测因素，制作了一个多变量二项逻辑回归模型。该模型转换为风险评分，然后使用 ROC 曲线在第二组患者中进行验证。
排除后，在推导（CholeS）队列中，7227 名患者的数据可用。手术时间中位数为 60 分钟（四分位间距 45-85），17.7%的手术时间超过 90 分钟。发现 10 个因素是手术时间>90 分钟的显著独立预测因素，包括 ASA、年龄、以前的手术入院、BMI、胆囊壁厚度和 CBD 直径。然后从这些因素中生成一个风险评分，并将其应用于来自三级中心的 2405 名患者的队列进行外部验证。ROC 曲线下面积为 0.708（SE=0.013，p<0.001），在评分的极端情况下，手术时间超过 90 分钟的比例从 5.1%增加到 41.8%。
在外部队列中验证时，本研究中生成的评分工具被发现对长手术时间具有显著预测能力。因此，该工具可能具有使组织能够更好地组织剧院清单并提高护理效率的潜力。
