Trent Oesophago-Gastric Unit, Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK.
World J Surg. 2019 Aug;43(8):1928-1934. doi: 10.1007/s00268-019-04981-5.
Day-case surgery is associated with significant patient and cost benefits. However, only 43% of cholecystectomy patients are discharged home the same day. One hypothesis is day-case cholecystectomy rates, defined as patients discharged the same day as their operation, may be improved by better assessment of patients using standard preoperative variables.
Data were extracted from a prospectively collected data set of cholecystectomy patients from 166 UK and Irish hospitals (CholeS). Cholecystectomies performed as elective procedures were divided into main (75%) and validation (25%) data sets. Preoperative predictors were identified, and a risk score of failed day case was devised using multivariate logistic regression. Receiver operating curve analysis was used to validate the score in the validation data set.
Of the 7426 elective cholecystectomies performed, 49% of these were discharged home the same day. Same-day discharge following cholecystectomy was less likely with older patients (OR 0.18, 95% CI 0.15-0.23), higher ASA scores (OR 0.19, 95% CI 0.15-0.23), complicated cholelithiasis (OR 0.38, 95% CI 0.31 to 0.48), male gender (OR 0.66, 95% CI 0.58-0.74), previous acute gallstone-related admissions (OR 0.54, 95% CI 0.48-0.60) and preoperative endoscopic intervention (OR 0.40, 95% CI 0.34-0.47). The CAAD score was developed using these variables. When applied to the validation subgroup, a CAAD score of ≤5 was associated with 80.8% successful day-case cholecystectomy compared with 19.2% associated with a CAAD score >5 (p < 0.001).
The CAAD score which utilises data readily available from clinic letters and electronic sources can predict same-day discharges following cholecystectomy.
日间手术具有显著的患者和成本效益。然而，只有 43%的胆囊切除术患者可以在同一天出院。一种假设是，通过更好地使用标准术前变量评估患者，日间胆囊切除术的比例（定义为在手术当天出院的患者）可能会提高。
从英国和爱尔兰 166 家医院前瞻性收集的胆囊切除术患者数据集（CholeS）中提取数据。将择期进行的胆囊切除术分为主要（75%）和验证（25%）数据集。确定术前预测因素，并使用多变量逻辑回归制定失败日间病例的风险评分。使用接收器工作曲线分析验证验证数据集中的评分。
在 7426 例择期胆囊切除术中，49%的患者在同一天出院。胆囊切除术后当天出院的可能性较小的患者为：年龄较大的患者（OR 0.18，95%CI 0.15-0.23），ASA 评分较高的患者（OR 0.19，95%CI 0.15-0.23），复杂的胆石症患者（OR 0.38，95%CI 0.31-0.48），男性患者（OR 0.66，95%CI 0.58-0.74），既往急性胆石相关入院患者（OR 0.54，95%CI 0.48-0.60）和术前内镜介入患者（OR 0.40，95%CI 0.34-0.47）。CAAD 评分是使用这些变量开发的。当应用于验证亚组时，CAAD 评分≤5 与 80.8%的成功日间胆囊切除术相关，而 CAAD 评分>5 与 19.2%的成功日间胆囊切除术相关（p<0.001）。
CAAD 评分利用诊所信件和电子来源中易于获得的数据，可以预测胆囊切除术后的当日出院。
