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Paredes, L., (2021). Escala Predictiva de colecistectomía laparoscópica difícil en colecistitis aguda [Tesis, Universidad Privada Antenor Orrego]. https://hdl.handle.net/20.500.12759/7645
Paredes, L., Escala Predictiva de colecistectomía laparoscópica difícil en colecistitis aguda [Tesis]. PE: Universidad Privada Antenor Orrego; 2021. https://hdl.handle.net/20.500.12759/7645
@misc{renati/371852,
title = "Escala Predictiva de colecistectomía laparoscópica difícil en colecistitis aguda",
author = "Paredes Macedo, Lizbeth Greta",
publisher = "Universidad Privada Antenor Orrego",
year = "2021"
}
Title: Escala Predictiva de colecistectomía laparoscópica difícil en colecistitis aguda
Authors(s): Paredes Macedo, Lizbeth Greta
Advisor(s): Burgos Chávez, Othoniel Abelardo
OCDE field: http://purl.org/pe-repo/ocde/ford#3.02.27
Issue Date: 2021
Institution: Universidad Privada Antenor Orrego
Abstract: Validar una escala predictiva de colecistectomía laparoscópica
difícil en colecistitis aguda.
MATERIAL Y MÉTODO: Se realizó un estudio de tipo observacional, analítico,
prospectivo de corte transversal en 190 historias clínicas de todos los pacientes
sometidos a colecistectomía laparoscópica por colecistitis aguda en los
hospitales de EsSalud nivel III durante el periodo comprendido entre Octubre
2019 – Marzo 2020. El proceso de selección fue realizado bajo los criterios de
inclusión y exclusión, considerándose solo 189 historias por motivos de
depuración. Se realizó el análisis multivariado mediante regresión logística. Y se
compararon dos subcohortes una de diseño (113) y otra subcohorte de
validación (76), buscando determinar un punto de corte para determinar la
dificultad de las colecistectomías laparoscópica (presencia de, al menos, una
complicación: lesión vascular o de la vía biliar, tiempo operatorio mayo a 1h y 30
minutos, o sangrado intraoperatorio y la necesidad de conversión a cirugía
abierta). Se elaboro una curva de ROC para determinar la capacidad predictiva
del modelo y el análisis de datos se hizo en Stat-ease.
RESULTADOS: cuatro predictores, que incluyen el grosor de la pared vesicular
≥ 4 cm, antecedente de cirugía abdominal superior, calculo impactado en
bacinete y antecedente de dolor previo, se asociaron significativamente y fueron
incluidos en la escala de colecistectomía laparoscópica difícil. Los coeficientes
de la escala derivada de la subcohorte diseño y de la subcohorte validación
fueron similares (p<0.005). la validación de la escala tuvo dos momentos, en un
primer momento se construyó el modelo con un subconjunto de pacientes, y en
un segundo momento, se validó el modelo con otro subconjunto de pacientes. El
modelo derivado de la subcohorte diseño tuvo buena discriminación (área bajo
la curva ROC:0.86) y la calibración (prueba de bondad de ajustes de Hosmer lemeshow, valor p>0.05) cuando se aplicó en la subcohorte validación.
CONCLUSION: La escala predictiva derivada de la subcohorte diseño obtuvo un
adecuado desempeño en la subcohorte validación. Se desarrollo un sistema de
puntuación para proporcionar una estimación simplificada y categorizada del
riesgo de dificultad en las colecistectomías laparoscópicas
To validate a predictive scale for difficult laparoscopic cholecystectomy in acute cholecystitis. MATERIAL AND METHOD: An observational, analytical, prospective cross sectional study was carried out in 190 medical records of all patients undergoing laparoscopic cholecystectomy for acute cholecystitis in EsSalud III hospitals during the period between October 2019 - March 2020. The selection process was carried out under the inclusion and exclusion criteria, considering only 189 stories for purification reasons. Multivariate analysis was performed using logistic regression. And two subcohorts, one design (113) and another validation subcohort (76), were compared, seeking to determine a cut-off point to determine the difficulty of laparoscopic cholecystectomies (presence of at least one complication: vascular injury or pathway). biliary, operative time May at 1 hour and 30 minutes, or intraoperative bleeding and the need to convert to open surgery). A ROC curve was elaborated to determine the predictive capacity of the model and the data analysis was done in Stat-easy. RESULTS: four predictors, including gallbladder wall thickness ≥ 4 cm, a history of upper abdominal surgery, an impacted calculus in the bacinete and a history of previous pain, were significantly associated and included in the difficult laparoscopic cholecystectomy scale. The coefficients of the scale derived from the design subcohort and the validation subcohort were similar (p <0.005). the validation of the scale had two moments, in the first moment the model was built with a subset of patients, and in a second moment, the model was validated with another subset of patients. The model derived from the design subcohort had good discrimination (area under the ROC curve: 0.86) and calibration (Hosmer lemeshow goodness-of-fit test, p value> 0.05) when applied to the validation subcohort. CONCLUSION: The predictive scale derived from the design subcohort obtained an adequate performance in the validation subcohort. A scoring system was developed to provide a simplified and categorized estimate of the risk of difficulty in laparoscopic cholecystectomies.
To validate a predictive scale for difficult laparoscopic cholecystectomy in acute cholecystitis. MATERIAL AND METHOD: An observational, analytical, prospective cross sectional study was carried out in 190 medical records of all patients undergoing laparoscopic cholecystectomy for acute cholecystitis in EsSalud III hospitals during the period between October 2019 - March 2020. The selection process was carried out under the inclusion and exclusion criteria, considering only 189 stories for purification reasons. Multivariate analysis was performed using logistic regression. And two subcohorts, one design (113) and another validation subcohort (76), were compared, seeking to determine a cut-off point to determine the difficulty of laparoscopic cholecystectomies (presence of at least one complication: vascular injury or pathway). biliary, operative time May at 1 hour and 30 minutes, or intraoperative bleeding and the need to convert to open surgery). A ROC curve was elaborated to determine the predictive capacity of the model and the data analysis was done in Stat-easy. RESULTS: four predictors, including gallbladder wall thickness ≥ 4 cm, a history of upper abdominal surgery, an impacted calculus in the bacinete and a history of previous pain, were significantly associated and included in the difficult laparoscopic cholecystectomy scale. The coefficients of the scale derived from the design subcohort and the validation subcohort were similar (p <0.005). the validation of the scale had two moments, in the first moment the model was built with a subset of patients, and in a second moment, the model was validated with another subset of patients. The model derived from the design subcohort had good discrimination (area under the ROC curve: 0.86) and calibration (Hosmer lemeshow goodness-of-fit test, p value> 0.05) when applied to the validation subcohort. CONCLUSION: The predictive scale derived from the design subcohort obtained an adequate performance in the validation subcohort. A scoring system was developed to provide a simplified and categorized estimate of the risk of difficulty in laparoscopic cholecystectomies.
Link to repository: https://hdl.handle.net/20.500.12759/7645
Discipline: Medicina
Grade or title grantor: Universidad Privada Antenor Orrego. Facultad de Medicina Humana
Grade or title: Médico Cirujano
Juror: Caballero Alvarado, José Antonio; Moreno Lázaro, Alberto de la Rosa; Ramírez Herrera, Milton
Register date: 14-Jun-2021
This item is licensed under a Creative Commons License