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Long-term outcomes of patients with common bile duct injury following laparoscopic cholecystectomy

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Abstract

Introduction

Common bile duct (CBD) injury is a serious and dreaded complication of cholecystectomy. A paucity of data assessing long-term outcomes exists. This study aimed to determine long-term mortality and liver transplantation rates following CBD injury requiring operative intervention.

Methods

Patients were identified via the New York State (NYS) Planning and Research Cooperative System longitudinal administrative database which captures patient-level data from every inpatient and outpatient hospital discharge in NYS. In total, 125 patients with CBD injuries were identified following 156,958 laparoscopic cholecystectomies for cholelithiasis performed in NYS from 2005 to 2010. Patients were then tracked by unique identifier to obtain rate of liver transplantation. Follow-up ranged from 4 to 9 years from surgery.

Results

There were 125 patients with CBD injuries detected. No mortalities occurred within 30 days. All-cause mortality was 20.8 % (n = 26) with mean time to death 1.64 ± 1.08 years. One patient who underwent hepaticoenterostomy required a liver transplant 4.3 years after surgery. Significant factors predictive of all-cause mortality included: age >61, Medicare insurance, male gender, White race, diabetes, hypertension and pulmonary complications following surgery. Overall 30-day morbidity, timing to and type of operative intervention did not influence mortality.

Conclusion

Considerable long-term mortality, 20.8 %, is associated with common bile duct injury requiring operative intervention. This was an increase of 8.8 % above the cohort’s expected age-adjusted rate of death. The mortality rate is appreciably higher than quoted previously. No difference was demonstrated by type of repair required. Liver transplant rate was 0.8 %. These data have significant implications for patient and family counseling both prior to cholecystectomy and following CBD injury.

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Acknowledgments

We acknowledge the biostatistical consultation and support from the Biostatistical Consulting Core at the School of Medicine, Stony Brook University. We would also like to acknowledge the support and guidance from Stony Brook University’s Surgical Outcome Analysis Research (SOAR) Collaborative.

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Authors and Affiliations

  1. Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA

    Caitlin Halbert, Maria S. Altieri, Mark Talamini, Aurora Pryor, Purvi Parikh & Dana A. Telem

  2. Department of Preventive Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA

    Jie Yang

  3. Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, USA

    Ziqi Meng & Hao Chen

  4. 537 Stanton-Christiana Road, Suite 102, Newark, DE, 19713, USA

    Caitlin Halbert

Authors
  1. Caitlin Halbert
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  2. Maria S. Altieri
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  3. Jie Yang
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  4. Ziqi Meng
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  5. Hao Chen
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  6. Mark Talamini
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  7. Aurora Pryor
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  8. Purvi Parikh
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  9. Dana A. Telem
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Corresponding author

Correspondence to Caitlin Halbert.

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Disclosures

Drs. Caitlin Halbert, Jie Yang, Maria Altieri, Purvi Parikh, Mark Talamini, Hao Chen and Ms. Ziqi Meng have no conflicts of interest. Dr. Aurora Pryor is a consultant for Intuitive and Freehold Medical. She is a speaker for Novadaq and Gore. She also has ownership in Transenteric. Dr. Dana Telem is a consultant for Gore and Ethicon and has research support from Cook and Surgiquest.

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Halbert, C., Altieri, M.S., Yang, J. et al. Long-term outcomes of patients with common bile duct injury following laparoscopic cholecystectomy. Surg Endosc 30, 4294–4299 (2016). https://doi.org/10.1007/s00464-016-4745-9

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  • DOI: https://doi.org/10.1007/s00464-016-4745-9

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