Abstract：
BACKGROUND: Laparoscopic cholecystectomy (LC) is the standard of care for symptomatic gall stone disease. A good scoring system is necessary to standardize the reporting. Our aim was to develop and validate an objective scoring system, the Surgical Cholecystectomy Score (SCS) to grade the difficulty of LC.
METHODS: The study was conducted in a single surgical unit at a tertiary care hospital in two phases from January 2017 to April 2021. Retrospective data was analysed and the difficulty of each procedure was graded according to the modified Nassar\'s scoring system. Significant preoperative and intraoperative data obtained was given a weightage score. In phase II, these scores were validated on a prospective cohort. Each procedure was classified either as easy, moderately difficult or difficult.
METHODS: A univariate analysis was performed on the data followed by a multivariate regression analysis. Bidirectional stepwise selection was done to select the most significant variables. The Beta /Schneeweiss scoring system was used to generate a rounded risk score.
RESULTS: Data of 800 patients was retrieved and graded. 10 intraoperative parameters were found to be significant. Each variable was assigned a rounded risk score. The final SCS range for intraoperative parameters was 0-15. The scoring system was validated on a cohort of 249 LC. In the final scoring, cut off SCS of > 8 was found to correlate with difficult procedures. Score of < 2 was equivalent to easy LC. A score between 2 and 8 indicated moderate difficulty. The area under ROC curve was 0.98 and 0.92 for the intraoperative score indicating that the score was an excellent measure of the difficulty level of LCs.
CONCLUSIONS: The scoring system developed in this study has shown an excellent correlation with the difficulty of LC. It needs to be validated in different cohorts and across multiple centers further.
METHODS: The study was conducted in a single surgical unit at a tertiary care hospital in two phases from January 2017 to April 2021. Retrospective data was analysed and the difficulty of each procedure was graded according to the modified Nassar\'s scoring system. Significant preoperative and intraoperative data obtained was given a weightage score. In phase II, these scores were validated on a prospective cohort. Each procedure was classified either as easy, moderately difficult or difficult.
METHODS: A univariate analysis was performed on the data followed by a multivariate regression analysis. Bidirectional stepwise selection was done to select the most significant variables. The Beta /Schneeweiss scoring system was used to generate a rounded risk score.
RESULTS: Data of 800 patients was retrieved and graded. 10 intraoperative parameters were found to be significant. Each variable was assigned a rounded risk score. The final SCS range for intraoperative parameters was 0-15. The scoring system was validated on a cohort of 249 LC. In the final scoring, cut off SCS of > 8 was found to correlate with difficult procedures. Score of < 2 was equivalent to easy LC. A score between 2 and 8 indicated moderate difficulty. The area under ROC curve was 0.98 and 0.92 for the intraoperative score indicating that the score was an excellent measure of the difficulty level of LCs.
CONCLUSIONS: The scoring system developed in this study has shown an excellent correlation with the difficulty of LC. It needs to be validated in different cohorts and across multiple centers further.
摘要：
背景：腹腔镜胆囊切除术（LC）是治疗症状性胆结石的标准方法。一个良好的评分系统对于规范报告是必要的。我们的目标是开发和验证一个客观的评分系统，手术胆囊切除术评分（SCS）对LC的难度进行分级。
方法：该研究于2017年1月至2021年4月在三级保健医院的单个外科单元中进行，分两个阶段进行。回顾性分析数据，并根据改良的Nassar评分系统对每个程序的难度进行评分。对获得的重要术前和术中数据进行加权评分。在第二阶段,这些评分在前瞻性队列中得到验证.每个程序都被归类为简单，适度困难或困难。
方法：对数据进行单变量分析，然后进行多元回归分析。进行双向逐步选择以选择最重要的变量。Beta/Schneeweiss评分系统用于生成四舍五入的风险评分。
结果：检索了800名患者的数据并进行分级。发现10个术中参数是重要的。每个变量被分配一个四舍五入的风险评分。术中参数的最终SCS范围为0-15。在249个LC的队列中验证了评分系统。在最后的得分中，发现切断>8的SCS与困难的程序有关。<2的分数相当于容易的LC。得分在2和8之间表示中等难度。术中评分的ROC曲线下面积为0.98和0.92，表明该评分是LCs难度水平的极好量度。
结论：本研究中开发的评分系统显示出与LC难度的良好相关性。它需要在不同的队列和跨多个中心进一步验证。
方法：该研究于2017年1月至2021年4月在三级保健医院的单个外科单元中进行，分两个阶段进行。回顾性分析数据，并根据改良的Nassar评分系统对每个程序的难度进行评分。对获得的重要术前和术中数据进行加权评分。在第二阶段,这些评分在前瞻性队列中得到验证.每个程序都被归类为简单，适度困难或困难。
方法：对数据进行单变量分析，然后进行多元回归分析。进行双向逐步选择以选择最重要的变量。Beta/Schneeweiss评分系统用于生成四舍五入的风险评分。
结果：检索了800名患者的数据并进行分级。发现10个术中参数是重要的。每个变量被分配一个四舍五入的风险评分。术中参数的最终SCS范围为0-15。在249个LC的队列中验证了评分系统。在最后的得分中，发现切断>8的SCS与困难的程序有关。<2的分数相当于容易的LC。得分在2和8之间表示中等难度。术中评分的ROC曲线下面积为0.98和0.92，表明该评分是LCs难度水平的极好量度。
结论：本研究中开发的评分系统显示出与LC难度的良好相关性。它需要在不同的队列和跨多个中心进一步验证。
