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

Sleep Duration and Obesity among Adolescents Transitioning to Adulthood: Do Results Differ by Sex?

OBJECTIVES: To examine the association between short sleep duration and obesity among adolescents (mean age 16 years) transitioning into young adulthood (mean age 21 years) in the National Longitudinal Study of Adolescent Health (N=10,076). STUDY DESIGN: Self-reported sleep duration was categorized as <6, 6-8, or >8 hours. Obesity status, using measured height and weight, was defined as Body Mass Index (BMI) ≥95(th) percentile in adolescence and BMI ≥30 kg/m(2) in young adulthood. RESULTS: Cross-sectionally, short sleep duration was associated with obesity in adolescent males (Prevalence Ratio (PR) 1.8 [95% CI: 1.3, 2.4]) but not in females (PR 1.0 [95% CI: 0.7, 1.4]). In longitudinal analyses, short sleep duration in adolescence was associated with incident obesity in both males and females (Risk Ratio (RR) 1.2 [95% CI: 1.0, 1.6]) in young adulthood. No interactions by sex were noted. CONCLUSIONS: Analyzing the association of sleep duration and obesity longitudinally resolved sex discrepancies observed in earlier cross-sectional analyses. Optimizing sleep duration during adolescence may be an effective intervention to prevent excess weight gain in young adults