Citation Information :
Mazni Y, Putranto AS, Mulyosaputro FP. Validation of CLOC Score in Predicting the Risk of Conversion from Laparoscopic to Open Cholecystectomy in Dr Cipto Mangunkusumo Hospital. World J Lap Surg 2022; 15 (2):157-162.
Introduction: Laparoscopic cholecystectomy is the gold standard for treatment of symptomatic cholelithiasis. Although relatively safe and effective, laparoscopic cholecystectomy is a difficult procedure. The rate of conversion to open cholecystectomy is estimated to be 1–15%. A preoperative predictive model may be helpful in determining whether open cholecystectomy is preferred over laparoscopic cholecystectomy to prevent morbidity and mortality associated with conversion. Conversion from laparoscopic to open cholecystectomy (CLOC) score can potentially predict the risk of conversion based on preoperative parameters. The purpose of this study is to validate the application of CLOC score in Dr Cipto Mangunkusumo Hospital's patient population.
Materials and methods: This was a retrospective study of patients undergoing laparoscopic cholecystectomy from January 2018 to December 2019 in Dr Cipto Mangunkusumo Hospital. Patient data were obtained from medical records. Descriptive analysis, Chi-square test, logistic regression analysis, and score validation using receiver-operating characteristic (ROC) curve by calculating the area under curve (AUC), sensitivity, and specificity were conducted. Based on the CLOC Score, the patients were stratified into two groups: low-risk (<6) and high-risk (>6).
Results: There were 163 subjects with a mean age of 51.06 ± 13.3 years. The rate of conversion was 3.1% (n = 5). Most of the subjects were 40–69 years of age (111 subjects, 68.1%). Of all 163 subjects, 103 (63.2%) were female. The indications for surgery were colicky pain (symptomatic gallstone disease) in 144 subjects (88.3%). Based on the logistic regression analysis, common bile duct dilation was found to be the only statistically significant variable [odds ratio (OR) = 10.97; 95% confidence interval (CI): 1.72–69.95]. The AUC approached 78.8% (fair) (95% CI: 58.2–99.4%; p = 0.029) for a cut-off value of 6.5 (sensitivity = 80.0%; specificity = 79.1%). The median duration of procedure in the low-risk group vs the high-risk group was 120 minutes (30–330) vs 180 minutes (45–405) (p = 0.001), respectively.
Conclusion: Common bile duct dilation was the only risk factor found to be significantly associated with conversion of laparoscopic cholecystectomy to open surgery. Other factors, such as age, sex, indication for surgery, gallbladder wall thickness, and ASA score were not found to be statistically significant risk factors. Conversion from laparoscopic to open cholecystectomy score was considered valid and useful in predicting the risk of conversion. A CLOC score of 7 or more was associated with a higher risk of conversion to open surgery.
Thami G, Singla D, Agrawal V, et al. A study of predictive factors in laparoscopic cholecystectomy determining conversion to open cholecystectomy with special reference to body mass index. J Evol Med Dent Sci 2015;4(74):12894–12898. DOI: 10.14260/jemds/2015/1859.
Al Masri S, Shaib Y, Edelbi M, et al. Predicting conversion from laparoscopic to open cholecystectomy: a single institution retrospective study. World J Surg 2018;42(8):2373–2382. DOI: 10.1007/s00268-018-4513-1.
Hu ASY, Menon R, Gunnarsson R, et al. Risk factors for conversion of laparoscopic cholecystectomy to open surgery - a systematic literature review of 30 studies. Am J Surg 2017;214(5):920–930. DOI: 10.1016/j.amjsurg.2017.07.029.
Sutcliffe RP, Hollyman M, Hodson J, et al. Preoperative risk factors for conversion from laparoscopic to open cholecystectomy: a validated risk score derived from a prospective UK database of 8820 patients. HPB 2016;18(11):922–928. DOI: 10.1016/j.hpb.2016.07.015.
Tayeb M, Rauf F, Bakhtiar N. Safety and feasibility of laparoscopic cholecystectomy in acute cholecystitis. J Coll Physicians Surg Pak 2018;28(10):798–800. PMID: 30266128.
Amin A, Haider MI, Aamir IS, et al. Preoperative and operative risk factors for conversion of laparoscopic cholecystectomy to open cholecystectomy in Pakistan. Cureus 2019;11(8):e5446. DOI: 10.7759/cureus.5446.
Souadka A, Naya MS, Serji B, et al. Impact of seniority on operative time and short-term outcome in laparoscopic cholecystectomy: experience of an academic Surgical Department in a developing country. J Minim Access Surg 2017;13(2):131–134. DOI: 10.4103/0972-9941.186687.
Zdichavsky M, Bashin YA, Blumenstock G, et al. Impact of risk factors for prolonged operative time in laparoscopic cholecystectomy. Eur J Gastroenterol Hepatol 2012;24(9):1033–1038. DOI: 10.1097/MEG.0b013e328354ad6e.
Bharamgoudar R, Sonsale A, Hodson J, et al. The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy. Surg Endosc 2018;32(7):3149–3157. DOI: 10.1007/s00464-018-6030-6.
Raman SR, Moradi D, Samaan BM, et al. The degree of gallbladder wall thickness and its impact on outcomes after laparoscopic cholecystectomy. Surg Endosc 2012;26(11):3174–3179. DOI: 10.1007/s00464-012-2310-8.
Sultan AM, El Nakeeb A, Elshehawy T, et al. Risk factors for conversion during laparoscopic cholecystectomy: retrospective analysis of ten years’ experience at a single tertiary referral centre. Dig Surg 2013;30(1):51–55. DOI: 10.1159/000347164.
Gholipour C, Fakhree MBA, Shalchi RA, et al. Prediction of conversion of laparoscopic cholecystectomy to open surgery with artificial neural networks. BMC Surg 2009;9:13. DOI: 10.1186/1471-2482-9-13.
Tafazal H, Spreadborough P, Zakai D, et al. Laparoscopic cholecystectomy: a prospective cohort study assessing the impact of grade of operating surgeon on operative time and 30-day morbidity. Ann R Coll Surg Engl 2018;100(3):178–184. DOI: 10.1308/rcsann.2017.0171.
Subhas G, Gupta A, Bhullar J, et al. Prolonged (longer than 3 hours) laparoscopic cholecystectomy: reasons and results. Am Surg 2011;77(8):981–984. PMID: 21944510.
Kim JH, Kim JW, Jeong IH, et al. Surgical outcomes of laparoscopic cholecystectomy for severe acute cholecystitis. J Gastrointest Surg 2008;12(5):829–835. DOI: 10.1007/s11605-008-0504-0.
Kauvar DS, Braswell A, Brown BD, et al. Influence of resident and attending surgeon seniority on operative performance in laparoscopic cholecystectomy. J Surg Res 2006;132(2):159–163. DOI: 10.1016/j.jss.2005.11.578.