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

Spies, debt and the well-spent penny: accounting and the Lisle agricultural estates 1533-1540

The Lisle family was one of the wealthiest families in England during the early Tudor period. Their wealth came primarily from agricultural estates. This research examines the family’s accounting during the period 1533 to 1540. We examine the family’s use of correspondence to an extensive network of spies, called privy friends, to secure allegiances, obtain information and help the family increase its agricultural land-holdings. We also examine the use of correspondence to facilitate cash flow through strategies to manage indebtedness. While the family’s agricultural holdings ensured its continuing wealth, the management of indebtedness, gifts and payments to privy friends were important for wealth accumulation. The strategies used by the Lisle family were responses to a turbulent, uncertain and ever-shifting political environment. We conclude that Tudor manorial estate accounting systems included both financial accounts and correspondence and that both must be considered when analysing the role of accounting information in single-entry accounting systems