External validation of the Cairns Prediction Model (CPM) to predict conversion from laparoscopic to open cholecystectomy

• Published in: The American journal of surgery 2018-11, Vol.216 (5), p.949-954
• Main Authors: Hu, Alan Shiun Yew, Donohue, Peter O’, Gunnarsson, Ronny K., de Costa, Alan
• Format: Article
• Language: English
• Subjects: Abdomen; Abdominal surgery; acute cholecystitis; Adolescent; Adult; Aged; Aged, 80 and over; Australia; Bile; Body mass index; cell carcinoma; Child; Cholecystectomy; Cholecystectomy, Laparoscopic; Conversion; Conversion to Open Surgery; Female; Gallbladder; Gallbladder Diseases - surgery; Hospitals; Humans; Kirurgi; Laparoscopy; laparotomy; Male; Middle Aged; Multivariate analysis; nomogram; Obesity; outcomes; Patients; Prediction models; Predictive Value of Tests; Retrospective Studies; Risk Factors; ROC Curve; score; Surgeons; Surgery; Ultrasonic imaging; Variables; Young Adult
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2018.03.016

Valid and user-friendly prediction models for conversion to open cholecystectomy allow for proper planning prior to surgery. The Cairns Prediction Model (CPM) has been in use clinically in the original study site for the past three years, but has not been tested at other sites. A retrospective, single-centred study collected ultrasonic measurements and clinical variables alongside with conversion status from consecutive patients who underwent laparoscopic cholecystectomy from 2013 to 2016 in The Townsville Hospital, North Queensland, Australia. An area under the curve (AUC) was calculated to externally validate of the CPM. Conversion was necessary in 43 (4.2%) out of 1035 patients. External validation showed an area under the curve of 0.87 (95% CI 0.82–0.93, p = 1.1 × 10−14). In comparison with most previously published models, which have an AUC of approximately 0.80 or less, the CPM has the highest AUC of all published prediction models both for internal and external validation. •Conversion at laparoscopic to open cholecystectomy is associated with adverse outcomes.•Cairns Prediction Model (CPM) has been in used predicting conversion in the original study site for the past threee years.•The model, which achieved an area under the curve (AUC) of 0.97, has not been tested at other sites.•External validation of the model was performed and showed an AUC of 0.87.•The CPM has the highest AUC of all published models for both internal and external validation.