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

Mechanical properties of thermoplastic natural rubber (TPNR) reinforced with different types of carbon nanotube

The effect of various multi-walled carbon nanotubes (MWNTs) on the tensile properties of thermoplastic natural rubber (TPNR) nanocomposite was investigated. The nanocomposite was prepared using melt blending method. MWNTs were added to improve the mechanical properties of MWNTs/TPNR composites in different compositions of 1, 3, 5, and 7 wt.%. The results showed that the mechanical properties of nanocomposites were affected significantly by the composition and the properties of MWNTs. SEM micrographs confirmed the homogenous dispersion of MWNTs in the TPNR matrix and promoted strong interfacial adhesion between MWNTs and the matrix which was improved mechanical properties significantl

Thermal behavior of MWNT-reinforced thermoplastic natural rubber nanocomposites

This article studies the thermal properties of a multi-walled carbon nanotube (MWNT)-reinforced thermoplastic natural rubber (TPNR) nanocomposite. The nanocomposite was prepared using a melt blending method. Various percentages (1, 3, 5, and 7 wt%) of MWNTs were added into TPNR to improve its thermal properties. The laser flash technique was also employed to determine the thermal conductivity, thermal diffusivity, and specific heat capacity of the nanocomposite. The DMA result showed that the glass transition temperature (Tg) increased with the increase in MWNT content. TEM micrographs also demonstrated that a good dispersion of MWNTs was achieved in the TPNR environment