Clinical, Anatomical, and Pathological Grading Score to Predict Technical Difficulty in Laparoscopic Splenectomy for Non-traumatic Diseases

Carlos Rodriguez-Otero Luppi, Eduardo M. Targarona Soler, Carmen Balague Ponz, Juan Pablo Pantoja Millán, Victor Turrado Rodriguez, Jose Luis Pallares Segura, Jesus Bollo Rodriguez, Manel Trias Folch

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7 Citations (Scopus)

Abstract

© 2016, Société Internationale de Chirurgie. Background: We aimed to develop a grading system based on preoperative parameters that would predict surgical difficulty and morbidity in elective laparoscopic splenectomy. Study design: 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. Results: 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. Conclusions: 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.
Original languageEnglish
Pages (from-to)439-448
JournalWorld Journal of Surgery
Volume41
Issue number2
DOIs
Publication statusPublished - 1 Feb 2017

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    Rodriguez-Otero Luppi, C., Targarona Soler, E. M., Balague Ponz, C., Pantoja Millán, J. P., Turrado Rodriguez, V., Pallares Segura, J. L., Bollo Rodriguez, J., & Trias Folch, M. (2017). Clinical, Anatomical, and Pathological Grading Score to Predict Technical Difficulty in Laparoscopic Splenectomy for Non-traumatic Diseases. World Journal of Surgery, 41(2), 439-448. https://doi.org/10.1007/s00268-016-3683-y