A novel preoperative scoring system to predict technical difficulty in laparoscopic splenectomy for non-traumatic diseas
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A novel preoperative scoring system to predict technical difficulty in laparoscopic splenectomy for non‑traumatic diseases Peng Liu1,2 · You Li3 · Hong‑Fan Ding1,2 · Ding‑Hui Dong1,2 · Xu‑Feng Zhang1,2 · Xue‑Min Liu1,2 · Yi Lv1,2 · Jun‑Xi Xiang1,2 Received: 2 October 2019 / Accepted: 19 December 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Laparoscopic splenectomy (LS) has been proven to be a safe and advantageous procedure. To ensure that resections of appropriate difficulty are selected, an objective preoperative grading of difficulty is required. We aimed to develop a predictive difficulty grading of LS based on intraoperative complications. Methods A total of 272 non-traumatic patients who underwent LS were identified from a regional medical center. Patients were randomized into a training cohort (n = 222) and a validation cohort (n = 50). Data on demographics, medical and surgical history, operative and pathological characteristics, and postoperative outcome details were collected. Univariate and multivariate analyses of risk factors for intraoperative complications were performed to develop a difficulty scoring system. The Spearman correlation coefficient was used to evaluate the relationship between the difficulty grading score and intraoperative outcomes. Receiver operating characteristic (ROC) curve was used to evaluate the discriminatory power of this scoring system. Results Three preoperative factors (spleen weight, esophagogastric varices, and INR) had a significant effect on operative time, bleeding, and conversion to open surgery. We created a difficulty grading score with three levels of difficulty: low (≤ 4 points), medium (5–6 points), and high (≥ 7 points), based on the three preoperative parameters. The correlation was highly significant (P 500 ml (%) Conversion to open surgery (%) Postoperative complications (%) Clavien I/II Clavien III Clavien IV Clavien V Postoperative stay (days, IQR)
46 (36–54) 106 (47.7)/116(52.3)
46 (37–54.5) 26 (52.0)/24(48.0)
147 (66.2) 59 (26.6) 16 (7.2) 432.0 (222.7–1008.0) 123 (55.4) 36 (16.2) 104 (46.8) 3.7 (3.2–4.2) 56.0 (36.0–105.5) 1.2 (1.1–1.3)
33 (66.0) 13 (26.0) 4 (8.0) 455.4 (177.0–768.6) 28 (56.0) 4 (8.0) 21 (42.0) 3.8 (3.1–4.5) 58.0 (30.0–126.0) 1.2 (1.0–1.3)
0.500 0.587 0.980
151 (68.0) 68 (30.6) 3 (1.4) 240 (180–323) 61 (27.5) 26 (11.7)
30 (60.0) 18 (36.0) 2 (4.0) 235 (178–300) 17 (34.0) 9 (18.0)
109 (88.6) 13 (10.6) 1(0.8) 0 10 (8–14)
21 (100) 0 0 0 9 (8–13.5)
0.527 0.939 0.138 0.534 0.290 0.567 0.577 0.218
0.322 0.357 0.230 0.330
0.232
EGV esophagogastric varices, RBC red blood cell, PLT blood platelet, INR international normalized ratio
odds ratio for each intraoperative complication. Compared with patients without esophagogastric varices, patients with EGV were 3.861 times (95% CI 1.035–14.4, P = 0.044) more likely to have a prolonged operative time and 6.863 times (95% CI 1.070–44.026, P = 0.042) more likely to convert to open surgery. The ris
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