Dataset Information

A new clinical-ultrasound score to predict difficult videolaparocholecystectomies: A prospective study.

ABSTRACT:

Background

The gold standard treatment of symptomatic cholelithiasis is videolaparoscopic cholecystectomy (VLC). The aim of this study is to produce a predictive clinical ultrasound (US) score for difficult VLC to reduce the rate of conversion to open cholecystectomy surgery and intra and/or post-operative complications.

Methods

In this prospective study carried out in 2017 we enrolled 135 patients (pts) who underwent VLC in our General Surgery Unit. A specific pre-operative abdominal ultrasound scan was performed to assess gallbladder characteristics for each patient. All US and patients' characteristics were recorded in a standard form in order to obtain a preoperative score and were then added to the intra-operative variables.

Results

The analysis revealed a statistical significance between post-operative characteristics and parietal thickness, adhesions, stratifications and volume of gallstones. Comparing the degree of difficulty VLC assessed in the pre-operative stage to the intraoperative score, the sensitivity of the preoperative US scan test is 91.8% while the specificity is 76.7%.

Conclusions

The variables which proved statistically significant in predicting a difficult cholecystectomy were: age, parietal thickness >3?mm, adhesions, stratifications, gallstones >2?cm and fixed gallstones. We have definitively defined a predictive score for difficult VLC for which a VLC is to be considered potentially difficult whenever it presents a pre-operative score equal or greater than 4 (and a "easy" one with a pre-operative score less than 4). These findings may prove helpful in further reducing the conversion rate and the rate of intra- and/or post-operative complications.

SUBMITTER: Carbotta G

PROVIDER: S-EPMC6170205 | biostudies-literature | 2018 Nov

REPOSITORIES: biostudies-literature

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Publications

A new clinical-ultrasound score to predict difficult videolaparocholecystectomies: A prospective study.

Carbotta Giuseppe G Panebianco Annunziata A Laforgia Rita R Pascazio Bianca B Balducci Giovanni G Bianchi Francesco Paolo FP Tafuri Silvio S Palasciano Nicola N

Annals of medicine and surgery (2012) 20180922

<h4>Background</h4>The gold standard treatment of symptomatic cholelithiasis is videolaparoscopic cholecystectomy (VLC). The aim of this study is to produce a predictive clinical ultrasound (US) score for difficult VLC to reduce the rate of conversion to open cholecystectomy surgery and intra and/or post-operative complications.<h4>Methods</h4>In this prospective study carried out in 2017 we enrolled 135 patients (pts) who underwent VLC in our General Surgery Unit. A specific pre-operative abdom ...[more]

PMID: 30294430

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Project description:BackgroundDiagnostic uncertainty in patients with dyspnea is associated with worse outcomes. We hypothesized that prehospital point-of-care ultrasound (POCUS) can improve diagnostic accuracy.MethodsProspective observational study of adult patients suffering dyspnea. Prehospital critical care physicians registered a suspected diagnosis based on clinical examination alone, performed POCUS of the heart and lungs, and finally registered suspected diagnoses based on their clinical examination supplemented with POCUS. Pre- and post-POCUS diagnoses were compared to endpoint committee adjudicated diagnoses. The primary outcome was improved sensitivity for diagnosing acute heart failure. Secondary outcomes included other diagnostic accuracy measures in relation to acute heart failure and other causes of dyspnea.ResultsIn total, 214 patients were included. The diagnosis of acute heart failure was suspected in 64/214 (30%) of patients before POCUS and 64/214 (30%) patients after POCUS, but POCUS led to reclassification in 53/214 (25%) patients. The endpoint committee adjudicated the diagnosis of acute heart failure in 87/214 (41%) patients. The sensitivity for the diagnosis of acute heart failure was 58% (95% CI 46%-69%) before POCUS compared to 65% (95% CI 53%-75%) after POCUS (p = 0.12). ROC AUC for the diagnosis acute heart failure was 0.72 (95% CI 0.66-0.78) before POCUS compared to 0.79 (0.73-0.84) after POCUS (p < 0.001). ROC AUC for the diagnosis acute exacerbation (AE) of chronic obstructive pulmonary disease (COPD) or asthma was 0.87 (0.82-0.91) before POCUS and 0.93 (0.88-0.97) after POCUS (p < 0.001). A POCUS finding of any of severely reduced left ventricular function, bilateral B-lines or bilateral pleural effusion demonstrated the highest sensitivity for acute heart failure at 88% (95% CI 79%-94%), whereas the combination of all of these three findings yielded the highest specificity at 99% (95% CI 95%-100%).ConclusionSupplementary prehospital POCUS leads to an improvement of diagnostic accuracy of both heart failure and AE-COPD/-asthma overall described by ROC AUC, but the increase in sensitivity for the diagnoses of acute heart failure did not reach statistical significance. Tailored use of POCUS findings optimizes diagnostic accuracy for rule-out and rule-in of acute heart failure.Trial registrationRegistered in Clinical Trials, 05.04.2019 (identifier: NCT03905460) https://clinicaltrials.gov/ct2/show/study/NCT03905460?term=NCT03905460&cond=Dyspnea&cntry=DK&draw=2&rank=1 .

Dataset Information

A new clinical-ultrasound score to predict difficult videolaparocholecystectomies: A prospective study.

Background

Methods

Results

Conclusions

Publications

A new clinical-ultrasound score to predict difficult videolaparocholecystectomies: A prospective study.

Similar Datasets

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