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

Accounting research and accounting practice The ambiguous relationship between the two

Lecture delivered at Aberystwyth on 27 Oct 1983SIGLEGBUnited Kingdo

Too big to fail and too big to succeed: accounting and privatisation in the Prison Service of England and Wales

This paper is concerned with the challenges involved in the transformation of the prison into a performance-oriented accounting entity. It examines the implication of private sector accounting and consulting expertise in redefining prison values and prison performance, and it discusses the consequences this had for definitions of risk and responsibility. The paper shows how the reforms promoted a systemic decentring of Prison Service accountability. Prison managers and regulators came to be inserted into hierarchies of expertise and credibility shaped by quests for commensuration and auditability. Further, the paper shows how the reform attempts brought about a situation of institutional lock-in by contributing, as the outgoing HM Chief Inspector of Prisons Anne Owers has put it in 2010, to the creation of an inflated prison system ‘too big to fail, and too big to succeed'