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

Validation of application SuperDuplicates (AS) enumeration tool for free-roaming dogs (FRD) in urban settings of Panchkula Municipal Corporation in North India

A cost-effective estimation of the number of free-roaming dogs is an essential prerequisite for the control of rabies in countries where the disease is endemic, as vaccination of at least 70% of the population is recommended to effectively control the disease. Although estimating the population size through sight-resight based maximum likelihood methodology generates an estimate closest to the actual size, it requires at least five survey efforts to achieve this. In a rural setting in India, a reliable estimate of at least 70% of the likely true population of free-roaming dogs was obtained with the Application SuperDuplicates shinyapp online tool using a photographic sight-resight technique through just two surveys. We tested the wider applicability of this method by validating its use in urban settings in India. Sight-resight surveys of free-roaming dogs were conducted in 15 sectors of the Panchkula Municipal Corporation in north India during September- October 2016. A total of 1,408 unique dogs were identified through 3,465 sightings on 14 survey tracks. The estimates obtained by the Application SuperDuplicates shinyapp online tool after two surveys were compared with the maximum likelihood estimates and it was found that the former, after two surveys, provided an estimate that was at least 70% of that obtained by the latter after 5–6 surveys. Thus, the Application SuperDuplicates shinyapp online tool provides an efficient means for estimating the minimum number of free-roaming dogs to vaccinate with a considerably lower effort than the traditional mark-resight based methods. We recommend use of this tool for estimating the vaccination target of free-roaming dogs prior to undertaking mass vaccination efforts against rabies