RESUMO
OBJECTIVE: To devise a classification system of patients subjected to elective laparoscopic cholecystectomy (LC) which will enable the degree of surgical difficulty and possible time in surgery to be correlated with clinical, ultrasound, associated comorbidity and age group variables. MATERIAL AND METHOD: A prospective observational study of 110 patients subjected to LC in which the SCCI (Surgical Complexity Classification Index) had been calculated. The SCCI was worked out from previous studies published on patient classification systems and complication predictive factors in patients subjected to LC. MAIN OUTCOME MEASURES: surgical technique difficulty score, length of surgical time, post-operative stay (ambulatory). RESULTS: The cut-off value that obtained a better classification of the patients was an SCCI > in whom the technique difficulty score was 13.2 +/- 3.6 and the duration of the surgery 51.9 +/- 31 compared with the SCCI < 5 subgroup, technical difficulty score 10.5 +/- 2.8 and the duration of the surgery 6.9 +/- 11.4 (p < 0.05). CONCLUSIONS: The SCCI enables the technical complexity of LC to be estimated and therefore appropriate risk management in the LC process together with improved clinical management of that process.
Assuntos
Colecistectomia Laparoscópica , Pacientes/classificação , Adulto , Idoso , Colecistectomia Laparoscópica/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
Objetivo. Elaborar un sistema de clasificación de pacientes sometidos a colecistectomía laparoscópica (CL) electiva que permita correlacionar el grado de dificultad quirúrgica y la posible duración de la cirugía en relación con variables clínicas y ecográficas, comorbilidades y segmentos de edad. Material y método. Estudio observacional prospectivo de 110 pacientes consecutivos sometidos a CL de quienes se ha calculado el índice de clasificación de complejidad quirúrgica (ICCQ), que se elaboró a partir de estudios previos publicados sobre sistemas de clasificación de pacientes y factores predictivos de complicaciones en pacientes sometidos a CL. Las principales medidas de resultados fueron score de dificultad técnica intraoperatoria, tiempo quirúrgico y estancia postoperatoria (ambulatorización). Resultados. El valor de corte que obtuvo una mejor clasificación de los pacientes fue ICCQ > 5, en cuyo subgrupo el score de dificultad técnica fue 13,2 ± 3,6 y la duración de la intervención, 51,9 ± 31 en comparación con el subgrupo de ICCQ < 5: score de dificultad técnica, 10,5 ± 2,8 y duración de la intervención, 36,9 ± 11,4 (p < 0,05). Conclusiones. El ICCQ permite estimar la complejidad técnica de la CL y, por lo tanto, la adecuada gestión de riesgos en el proceso de la CL junto con una mejora en la gestión clínica de dicho proceso (AU)
Objective. To devise a classification system of patients subjected to elective laparoscopic cholecystectomy (LC) which will enable the degree of surgical difficulty and possible time in surgery to be correlated with clinical, ultrasound, associated comorbidity and age group variables. Material and method. A prospective observational study of 110 patients subjected to LC in which the SCCI (Surgical Complexity Classification Index) had been calculated. The SCCI was worked out from previous studies published on patient classification systems and complication predictive factors in patients subjected to LC. Main outcome measures: surgical technique difficulty score, length of surgical time, post-operative stay (ambulatory). Results. The cut-off value that obtained a better classification of the patients was an SCCI > in whom the technique difficulty score was 13.2 ± 3.6 and the duration of the surgery 51.9 ± 31 compared with the SCCI < 5 subgroup, technical difficulty score 10.5 ± 2.8 and the duration of the surgery 6.9 ± 11.4 (p < 0.05). Conclusions. The SCCI enables the technical complexity of LC to be estimated and therefore appropriate risk management in the LC process together with improved clinical management of that process (AU)