128 The Utility of Applying Difficult Cholecystectomy Predictive Scoring in a Real-World Population – the Experience at a Large Tertiary Upper-GI and Hepato-Biliary Centre

Abstract Background Cholecystectomy is in ever increasing demand. Procedures can vary from very straightforward to extremely challenging - with patient course often being governed by operative difficulty. Multiple scores have been previously created to predict difficult cholecystectomy, but with no consensus on utilisation, routine use is low. A predictive score could better inform patients, whilst allowing appropriate planning for procedural and post-operative arrangements (day case/inpatient bed/staffing). We examine an established risk score – the Cholecystectomy as a Day Case (CAAD) score - in our cholecystectomy population, to evaluate its utility. Method A sequential cohort of cholecystectomy patients, identified by pathology specimens, from a single centre were included. Patients were categorised by CAAD score (≤5 and >5). Outcome measures include length of stay, need for conversion, and post-operative complications. Hazard ratios were calculated, and Pearson’s Chi squared test was used to assess for significance level between groups. Results Following exclusions, 194 patients were suitable for inclusion. There were 82 same day discharges, 4 conversions to open, and 39 post-operative complications. There were no deaths. A CAAD score of >5 correlated significantly with increased complications rate (37.5% vs 7.9%, HR 4.7, p = 0.000001) and inpatient stay/non-same day discharge (80% vs 42.2%, HR 1.9, p = 0.0000003). Low scores however did not significantly predict the absence of complications, but did correlate with completion laparoscopically. Conclusions High CAAD scores correlate with increased need for inpatient stay and higher complication rates. Utilising these scores could help predict high risk patients and allow for appropriate planning in these cases.