Ciria R, Padial A, Ayllón MD, García-Gaitan C, Briceño J. Fast-track protocols in laparoscopic liver surgery: Applicability and correlation with difficulty scoring systems. World J Gastrointest Surg 2022; 14(3): 211-220 [PMID: 35432762 DOI: 10.4240/wjgs.v14.i3.211]
Corresponding Author of This Article
Ruben Ciria, FEBS, MD, PhD, Surgeon, Unit of Hepatobiliary Surgery and Liver Transplantation, University Hospital Reina Sofia, Avenida Menéndez Pidal s/n, Cordoba 14004, Spain. rubenciria@gmail.com
Research Domain of This Article
Surgery
Article-Type of This Article
Case Control Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Mar 27, 2022; 14(3): 211-220 Published online Mar 27, 2022. doi: 10.4240/wjgs.v14.i3.211
Fast-track protocols in laparoscopic liver surgery: Applicability and correlation with difficulty scoring systems
Ruben Ciria, Ana Padial, María Dolores Ayllón, Carmen García-Gaitan, Javier Briceño
Ruben Ciria, Ana Padial, María Dolores Ayllón, Javier Briceño, Unit of Hepatobiliary Surgery and Liver Transplantation, University Hospital Reina Sofia, Cordoba 14004, Spain
Carmen García-Gaitan, Unit of Anesthesiology, University Hospital Reina Sofia, Cordoba 14004, Spain
Author contributions: Ciria R and Ayllón MD designed the research study; Ciria R, Ayllón MD, Padial A and García-Gaitan C performed the research; all authors analyzed the data and wrote the manuscript; All authors have read and approved the final manuscript; Ciria R and Padial A have equally contributed to the development of this manuscript and research.
Institutional review board statement: Approval number of the institutional review board of the University Hospital Reina Sofia was 4380 (Code 0000-0002).
Conflict-of-interest statement: The authors declare no conflict of interest in none of the contents within the development of the manuscript.
Data sharing statement: Technical appendix, statistical code and dataset available from the corresponding author at rubenciria@gmail.com. Participants gave informed consent for data sharing.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ruben Ciria, FEBS, MD, PhD, Surgeon, Unit of Hepatobiliary Surgery and Liver Transplantation, University Hospital Reina Sofia, Avenida Menéndez Pidal s/n, Cordoba 14004, Spain. rubenciria@gmail.com
Received: April 19, 2021 Peer-review started: April 19, 2021 First decision: June 13, 2021 Revised: July 25, 2021 Accepted: February 9, 2022 Article in press: February 9, 2022 Published online: March 27, 2022
ARTICLE HIGHLIGHTS
Research background
There is a lack of evidence regarding the correlation between laparoscopic liver surgery (LLS) difficulty scoring systems and accomplishment of fast-track protocols (FTP).
Research motivation
The main motivation is to identify if current difficulty scoring systems may be used to predict early discharging policies and development of complications after LLS within an FTP.
Research objectives
The main objectives are to define if difficulty scoring systems may predict accomplishment of FTPs in LLS and to determine variables that may complement these scoring systems to increase their prediction capabilities.
Research methods
We analyzed out patients included in an FTP and compared Iwate, Southampton and Gayet’s scoring systems. Comparisons were also made in some sets of patients who were included in 24-h and 48-h early discharge protocols for both minor and major resections, respectively.
Research results
Our selection criteria was successful with more than 70% of our patients being discharged in less than 72 h. Iwate scoring system was the most accurate to predict 24-h discharge with an area under the receiver operating characteristic = 0.78 and 87.7% and 66.7% for sensitivity and specificity values, respectively, and a cutoff of 5.5 points.
Research conclusions
Iwate difficulty score is the most accurate to predict adhesion to an FTP after LLS. Body mass index was considered as an independent risk factor that should be added to current scoring systems.
Research perspectives
Incoming difficulty scoring systems may be further evaluated to include variables not considered to date.
