Investigating precise control pathway for haemostatic clip usage in laparoscopic cholecystectomy based on patient clinical variations: an exploratory retrospective observational study

• Published in: BMJ open 2024-08, Vol.14 (8), p.e082072
• Main Authors: Yu, Xiru, Wang, Xiaodong, Li, Ang, Su, Jiao, Du, Wei, Liu, Yu, Zeng, Wenqi, Yan, Ling, Zhao, Ying
• Format: Article
• Language: English
• Subjects: Adult; Aged; Blood groups; Blood Loss, Surgical - statistics & numerical data; China; Cholecystectomy; Cholecystectomy, Laparoscopic - methods; Decision Making; Female; Gallbladder; Gallbladder diseases; Health care policy; HEALTH SERVICES ADMINISTRATION & MANAGEMENT; Health Services Research; Hepatobiliary surgery; Hospitals; Humans; Hypertension; Injuries; Laparoscopy; Liver cirrhosis; Male; Medical equipment; Medical records; Medical technology; Methods; Middle Aged; Original Research; Patients; Public Hospitals; Retrospective Studies; Surgery; Surgical Instruments; Variables
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2023-082072

ObjectivesTo explore a precise control pathway based on patient clinical variations for haemostatic clip usage in laparoscopic cholecystectomy (LC) through on-site research data from a teaching hospital. Specifically, the study aimed to: (1) to calculate the optimal haemostatic clip consumption in LC based on diagnostic grouping and surgical combinations, and (2) to provide evidence for cost containment of high-value medical consumables used in LC.DesignRetrospective observational study.SettingHospital in southwest China.ParticipantsThe inclusion criteria were set as inpatients whose medical records included International Classification of Diseases codes 1–3 with code 51.2300 (corresponding to LC surgery) and who were discharged on medical advice. A dataset containing 1001 patients without any haematological diagnoses was collected.Primary and secondary outcome measuresTwo ordered multinomial logit models were established to identify factors affecting haemostatic clip use in LC. Two-step clustering was used to form subgroups. The premodel included preoperative variables (acute cholecystitis and scarring/fibrotic atrophy), while the full model added intraoperative variables (anatomical variation and severe adhesions). Both models met application prerequisites.ResultsKey factors influencing haemostatic clip usage were identified, including acute cholecystitis, scarring/fibrotic atrophy, anatomical variation and severe adhesions. Consumption references for haemostatic clips were established for LC patients with good prognoses on discharge. The ordered multinomial logit model revealed that acute cholecystitis decreased the odds of using four or more clips (p