The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Reshma Bharamgoudar, Aniket Sonsale, James Hodson, Ewen Griffiths*, Ravinder S. Vohra, Amanda J. Kirkham, Sandro Pasquali, Paul Marriott, Marianne Johnstone, Philip Spreadborough, Derek Alderson, Ewen A. Griffiths, Stephen Fenwick, Mohamed Elmasry, Quentin M. Nunes, David Kennedy, Raja Basit Khan, Muhammad A.S. Khan, Conor J. Magee, Steven M. JonesDenise Mason, Ciny P. Parappally, Pawan Mathur, Michael Saunders, Sara Jamel, Samer Ul Haque, Sara Zafar, Muhammad Hanif Shiwani, Nehemiah Samuel, Farooq Dar, Jonathan Heath, Jane M. Blazeby, Angus G.K. McNair, Joanna Reed, Shabuddin Khan, Steven J. Robinson, Simon J. Dwerryhouse, Simon M. Higgs, Oliver J. Old, Lucinda Frank, Robert P. Jones, Geoffrey P. Roberts, Adam Chambers, Alistair Reid, James Gardner-Thorpe, Jack Martin, Adam Chambers, Benjamin Knight, Richard Krysztopik, James Kynaston, On Behalf Of The Choles Study Group, West Midlands Research Collaborative

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

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Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p < 0.001), with the proportions of operations lasting > 90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care.

Original languageEnglish
Pages (from-to)1-9
Number of pages9
JournalSurgical Endoscopy
Issue number7
Early online date16 Jan 2018
Publication statusE-pub ahead of print - 16 Jan 2018

Structured keywords

  • Centre for Surgical Research


  • Laparoscopic cholecystectomy
  • Operative duration
  • Patient factors
  • Prediction
  • Scoring tool
  • Theatre utilisation


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