Liu et al reported a score for predicting difficulty of a laparoscopic splenectomy performed for a non-traumatic disorder. This can help to identify a patient who may require more aggressive management. The authors are from Xi'an Jiaotong University and Fudan University in China.
Patient selection: laparoscopic splenectomy, other than trauma
Parameters:
(1) splenic weight in grams
(2) esophagogastric varices (EGV)
(3) INR
Parameter
Finding
Points
splenic weight
< 400 grams
1
400 to 1,500 grams
2
> 1,500 grams
4
esophagogastric varices
no
1
yes
2
INR
< 1.1
1
>= 1.1
2
total score =
= SUM(points for all 3 parameters)
Interpretation:
• minimum score: 3
• maximum score: 8
• The higher the score the greater the difficulty, with longer operative times, greater blood loss and a high rate of conversion to an open procedure.
Total Score
Risk Group
Conversion to Open
3 or 4
low
4%
5 or 6
medium
11%
7 or 8
high
36%
Performance:
• The area under the ROC curve is 0.7 in the derivation and 0.73 in validation cohorts.
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