The Cholecystectomy As A Day Case (CAAD) Score: A Validated Score of Preoperative Predictors of Successful Day-Case Cholecystectomy Using the CholeS Data Set

Background Day-case surgery is associated with significant patient and cost benefits. However, only 43% of cholecystectomy patients are discharged home the same day. One hypothesis is day-case cholecystectomy rates, defined as patients discharged the same day as their operation, may be improved by better assessment of patients using standard preoperative variables. Methods Data were extracted from a prospectively collected data set of cholecystectomy patients from 166 UK and Irish hospitals (CholeS). Cholecystectomies performed as elective procedures were divided into main (75%) and validation (25%) data sets. Preoperative predictors were identified, and a risk score of failed day case was devised using multivariate logistic regression. Receiver operating curve analysis was used to validate the score in the validation data set. Results Of the 7426 elective cholecystectomies performed, 49% of these were discharged home the same day. Same-day discharge following cholecystectomy was less likely with older patients (OR 0.18, 95% CI 0.15–0.23), higher ASA scores (OR 0.19, 95% CI 0.15–0.23), complicated cholelithiasis (OR 0.38, 95% CI 0.31 to 0.48), male gender (OR 0.66, 95% CI 0.58–0.74), previous acute gallstone-related admissions (OR 0.54, 95% CI 0.48–0.60) and preoperative endoscopic intervention (OR 0.40, 95% CI 0.34–0.47). The CAAD score was developed using these variables. When applied to the validation subgroup, a CAAD score of ≤5 was associated with 80.8% successful day-case cholecystectomy compared with 19.2% associated with a CAAD score >5 (p < 0.001). Conclusions The CAAD score which utilises data readily available from clinic letters and electronic sources can predict same-day discharges following cholecystectomy

Structure of high-lying levels populated in the 96^{96}Y →96\rightarrow ^{96}Zr β\beta decay

The nature of $J^{\pi}=1^-$ levels of $^{96}$Zr below the $\beta$-decay $Q_{\beta}$ value of $^{96}$Y has been investigated in high-resolution $\gamma$-ray spectroscopy following the $\beta$ decay as well as in a campaign of inelastic photon scattering experiments. Branching ratios extracted from $\beta$ decay allow the absolute $E1$ excitation strength to be determined for levels populated in both reactions. The combined data represents a comprehensive approach to the wavefunction of $1^-$ levels below the $Q_{\beta}$ value, which are investigated in the theoretical approach of the Quasiparticle Phonon Model. This study clarifies the nuclear structure properties associated with the enhanced population of high-lying levels in the $^{96}$Y$_{gs}$ $\beta$ decay, one of the three most important contributors to the high-energy reactor antineutrino spectrum