Establishment And Verification Of Risk Predictive Model Of Converting Laparoscopic To Open Cholecystectomy Based On Meta-analysis

Objectives:The purpose of this study is to establish the risk predictive model for conversion of laparoscopic cholecystectomy to open cholecystectomy by using Meta-analysis,to screen risk factors for the laparotomy and to provide evidence-based medical evidence for the surgical protocol,finally to avoid the occurrence of conversion to open cholecystectomy.Methods:Meta-analysis:By making the exclusion criteria and retrieval strategy,the literature related to the risk factors of converting laparoscopic to open cholecystectomy were retrieved and the relevant data were extracted,and the Meta-analysis was carried out using RevMan 5.2 and STATA12.0 software.Establish the Model:The risk of converting Laparoscopic to Open Cholecystectomy calculated in the meta-analysis was combined into the Logistic regression model to establish a laparoscopic cholecystectomy conversion risk assessment model.Model validation:A case of laparoscopic cholecystectomy performed at a tertiary hospital in 2010-2017 was taken and the established model was validated.The ROC curve was used as a model to establish a standard for evaluating the effect.Results:Meta-analysis results:Meta-analysis of laparoscopic cholecystectomy for open laparotomy risk factors included a total of 25 articles,including 34912 cases of cumulative laparoscopic cholecystectomy,of which 2681 were converted to laparotomy.In these studies,A total of 11 risk factors entered the model:sex,age,onset time≥72h,upper abdominal surgery history,cholecystitis recurrence,diabetes mellitus,BMI index≥25,thick gallbladder wall,gallbladder stone incarceration,leucocyte level ≥9.6x109/1,total bilirubin level ≥17.1 u mol/1,combined risk(or values)are:1.62,2.23,3.72,4.15,4.03,2.11,1.52,4.54,3.38,3.18,and 2.83 respectively.The risk prediction model constructed based on the results of the Meta-analysis is as follows Logit(P)=a + 0.48X1 + 0.80X2 + 1.31X3 + 1.42X4 + 1.39X5 + 0.75X6 + 0.42X7 + 1.51X8 + 1.22X9 + 1.16X10 +1.04X11Model Validation Results:The AUC and 95%ci of the prognosis of laparoscopic cholecystectomy converted to laparotomy model were 0.854(0.792-0.916).Each risk factor was assigned and a scoring system was constructed.When the score was 56 points,the conversion rate was as high as 90%.Conclusions:In this study,a combination of meta-analysis and a Logistic regression model was used to establish a risk prediction model for conversion to laparotomy in laparoscopic cholecystectomy.It is proved that the method has good predictive efficiency.By assigning risk factors,a laparoscopic cholecystectomy conversion laparotomy risk scoring system was constructed to make the study results more convenient and efficient in clinical use.It can be used to provide a reference for clinicians to choose preoperative surgical methods.