The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Determinants of Treatment Access in a Population-based Cohort of HIV-positive Men and Women Living in Argentina

Objective: To report emerging data on the use of highly active antiretroviral therapy (HAART)in Argentina by assessing patterns of HAART access and late vs early treatment initiation in apopulation-based cohort of adults infected with HIV type-1.Design: The Prospective Study on the Use and Monitoring of Antiretroviral Therapy (PUMA) is astudy of 883 HIV-positive individuals enrolled in the Argentinean drug treatment program.Individuals were 16 years of age and older and were recruited from 10 clinics across Argentina.Methods: Sociodemographic and clinical characteristics were examined using contingency tables(Pearson chi-square test and Fisher exact test) for categoric variables and Wilcoxon rank-sum testfor continuous variables. To analyze time to initiation of HAART we used Kaplan-Meier methodsand Cox regression.Results: Patients who initiated HAART were more likely to be older, have an AIDS-defining illness,be an injection drug user (IDU), have a lower median CD4 cell count, have a higher median viralload, and be less likely to be men who have sex with men (MSM). In multivariate analysis, AIDSdefiningillness and plasma viral load were significantly associated with time to starting therapy.Patients who received late access were more likely to be diagnosed with AIDS and have highermedian plasma viral loads than those receiving early access.Conclusion: Our results indicate that despite free availability of treatment, monitoring, and carein Argentina, a significant proportion of men and women are accessing HAART late in the courseof HIV disease. Further characterization of the HIV-positive population will allow for a morecomprehensive evaluation of the impact of HAART within the Argentinean drug treatmentprogram