Risk prediction score in laparoscopic colorectal surgery training: experience from the English National Training
Hugh Mackenzie1, Danilo Miskovic, Melody Ni
1*Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, London, United Kingdom †John Golligher Colorectal Unit, The Leeds Teaching Hospitals, Leeds, United Kingdom ‡Department of Colorectal Surgery, Singapore General Hospital, Singapore §Department of Colorectal Surgery, University Hospitals Case Medical Center, Cleveland, OH; and ‖Department of Colorectal Surgery, Derriford Hospital, Plymouth, United Kingdom.
Annals of Surgery
|March 21, 2014
Summary
A new risk score helps select cases for laparoscopic colorectal surgery training. This score predicts complications and identifies high-risk training cases, improving patient safety.
Area of Science:
- Surgical training and patient safety
- Colorectal surgery outcomes
- Risk prediction modeling
Background:
- Existing risk scores are not suitable for surgical training or multi-institutional use.
- Training environments require specific tools to manage patient risk.
Purpose of the Study:
- To develop and validate a risk prediction score for laparoscopic colorectal surgery training cases.
- To assess the score's ability to predict adverse outcomes and guide trainer intervention.
Main Methods:
- Analysis of a national database of 2341 laparoscopic colorectal surgery training cases (2008-2012).
- Logistic regression identified independent risk factors for conversion.
- A risk score was created, and its clinical impact evaluated using postoperative complications and trainer input.
- External datasets (786 cases) were used for validation.
Main Results:
- Significant risk factors for conversion included BMI, ASA classification, male sex, prior surgery, and resection type.
- A risk score >6 correlated with increased mortality (2.9% vs 0.5%), anastomotic leak (4.3% vs 1.4%), and trainer input (32.2% vs 19.9%).
- External validation confirmed higher conversion, complication, and leak rates in predicted high-risk cases.
Conclusions:
- A validated risk prediction score for laparoscopic colorectal surgery training has been developed.
- This score aids in selecting appropriate training cases, potentially enhancing patient safety and training efficiency.
