A comparison of cholecystitis grading scales

Background Previously, our group developed the Parkland Grading Scale for Cholecystitis (PGS) to stratify gallbladder (GB) disease severity that can be determined immediately when performing laparoscopic cholecystectomy (LC). In prior studies, PGS demonstrated excellent interrater reliability and was internally validated as an accurate measure of LC outcomes. Here, we compare PGS against a more complex cholecystitis severity score developed by the national trauma society (AAST), which requires clinical, operative, imaging, and pathologic inputs, as a predictor of LC outcomes. Study Design Eleven Acute Care Surgeons prospectively graded 179 GBs using PGS and filled out a post-operative questionnaire regarding the difficulty of the surgery. Three independent raters retrospectively graded these GBs using PGS from images stored in the electronic medical record (EMR). Three additional surgeons then assigned separate AAST scores to each GB. The Intraclass Correlation Coefficient (ICC) statistic assessed rater reliability for both PGS and AAST. The PGS score and the median AAST score became predictors in separate linear, logistic, and negative binomial regression models to estimate peri-operative outcomes. Results The average ICC of PGS and AAST was 0.8647 and 0.8341, respectively. PGS was found to be a superior predictor of increasing operative difficulty (R2 0.566 vs 0.202), case length (R2 0.217 vs 0.037), open conversion rates (AUC 0.904 vs 0.757), and complication rates (AUC 0.7039 vs 0.6474) defined as retained stone, small bowel obstruction, wound infection, or postoperative biliary leak. PGS performed similar to AAST in predicting partial cholecystectomy, readmission, bile leak rates, and length of stay. Conclusion Both PGS and AAST are accurate predictors of LC outcomes. PGS was found to be a superior predictor of subjective operative difficulty, case length, open conversion rates, and complication rates. PGS has the advantage of being a simpler, operative based scale which can be scored at a single point in time. Level of Evidence IV. Single institution, retrospective review. Corresponding author: Michael W. Cripps, MD, University of Texas Southwestern Medical Center, Division of General and Acute Care Surgery, 5323 Harry Hines Blvd. Dallas, Texas 75390-9158, Office: 214-648-2708, Fax: 214-648-5477, michael.cripps@utsouthwestern.edu Meeting submitted and conflicts of interest: This original work will be presented as an oral at the 2018 American College of Surgeons Clinical Congress, October 21-25, 2018 in Boston, Massachusetts and has not been published elsewhere. The authors have no conflicts of interest to disclose. © 2018 Lippincott Williams & Wilkins, Inc.

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