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

URBAN FIELDS IN THE MAKING: NEW EVIDENCE FROM A DANISH CONTEXT

This paper analyses the development of the scale of spatial interaction in Denmark and its consequences for commute patterns around the country's two largest cities. The methods used are GIS-based mapping of commuter flows and analysis of the changing correlation between centrality and commuting from 1982 to 2002. The distances bridged by commuting and the size of functional regions have expanded markedly. The consequences for commute patterns depend on the regional context. In the case of the capital area, the expanding scale of interaction is equivalent to an expanded commuter field around the capital. The significance of the centre of the capital for commuting has increased from 1982 to 2002. In the case of East Jutland, where many mid-sized historical centres are located close to each other, the development is in the direction of a polycentric urban region with decreased significance of any single centre in attracting and focusing the commute pattern. Copyright (c) 2005 by the Royal Dutch Geographical Society KNAG.