Key result
A predictive nomogram incorporating 8 clinical variables demonstrated moderate discrimination for identifying patients requiring prolonged PACU length of stay after laparoscopic cholecystectomy, with a C-index of 0.662 in the training set.
Why the study?
Prolonged length of stay in the postanesthesia care unit after laparoscopic cholecystectomy may lead to overcrowding and reduced medical resource utilization.
Observational (n=913)
No
A newly developed nomogram using 8 preoperative variables showed moderate discrimination for predicting prolonged PACU length of stay after laparoscopic cholecystectomy.
Answers are grounded in this paper and cite their sources.
May support preoperative risk stratification after laparoscopic cholecystectomy; leaves open external validation before clinical use.
Background: Laparoscopic Cholecystectomy (LC) is a common surgical procedure for managing gallbladder disease. Prolonged length of stay (LOS) in the postanesthesia care unit (PACU) may lead to overcrowding and a decline in medical resource utilization. In this work, we aimed to develop and validate a predictive nomogram for identifying patients who require prolonged PACU LOS. Methods: Data from 913 patients undergoing LC at a single institution in China between 2018 and 2019 were collected, and grouped into a training set (cases during 2018) and a test set (cases during 2019). Using the least absolute shrinkage and selection operator regression model, the optimal feature was selected, and multivariable logistic regression analysis was used to build the prolonged PACU LOS risk model. The C -index, calibration plot, and decision curve analysis were used in assessing the model calibration, discrimination, and clinical application value, respectively. For external validation, the test set data was evaluated. Results: The predictive nomogram had 8 predictor variables for prolonged PACU LOS, including age, ASA grade, active smoker, gastrointestinal disease, liver disease, and cardiovascular disease. This model displayed efficient calibration and moderate discrimination with a C -index of 0.662 (95% confidence interval, 0.603 to 0.721) for the training set, and 0.609 (95% confidence interval, 0.549 to 0.669) for the test set. Decision curve analysis demonstrated that the prolonged PACU LOS nomogram was reliable for clinical application when an intervention was decided at the possible threshold of 7%. Conclusions: We developed and validated a predictive nomogram with efficient calibration and moderate discrimination, and can be applied to identify patients most likely to be subjected to prolonged PACU LOS. This novel tool may shun overcrowding in PACU and optimize medical resource utilization.
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Cao et al. (2020) conducted an observational in Laparoscopic Cholecystectomy (n=913). Predictive nomogram for prolonged PACU LOS was evaluated on Prolonged PACU length of stay prediction (C-index) (C-index 0.662, 95% CI 0.603-0.721). A predictive nomogram incorporating 8 clinical variables demonstrated moderate discrimination for identifying patients requiring prolonged PACU length of stay after laparoscopic cholecystectomy, with a C-index of 0.662 in the training set.
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