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Increasing bile duct injury and decreasing utilization of intraoperative cholangiogram and common bile duct exploration over 14 years: an analysis of outcomes in New York State

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Abstract

Introduction

During laparoscopic cholecystectomy (LC), common bile duct (CBD) visualization either directly or with cholangiography (IOC) is less routine. Cholangiography can be used to identify and possibly prevent bile duct injury (BDI), which is a dreaded complication of cholecystectomy. The purpose of our study was to evaluate the trend of IOC/CBD exploration and BDI during LC for benign disease.

Methods

A state-wide database (SPARCS) was used to identify all LC for benign biliary non-obstructive and obstructive disease between 2000 and 2014 in the state of New York. ICD-9 and CPT codes were used to identify IOC/CBD exploration and BDI. Multivariable logistic regression models were used in examining the linear trend in the risk of complication, 30-day readmission, 30-day ED visits, and BDI among all cholangiogram patients after controlling for possible confounding factors.

Results

During 2000–2014, 391,945 patients underwent laparoscopic cholecystectomy. The trend of IOC/CBD exploration performed significantly decreased for LC overall (12.37–10.44%, relative risk = 0.98, p <.0001) and particularly, in the outpatient setting (10.77–7.52%, relative risk = 0.96, p value <.0001). Among patients with IOC, overall complication rate, 30-day readmission rate, and 30-day ED visit rates increased. When looking at overall complication rate, there was an increase by about 4% per year (relative risk = 1.04, p value <.0001). After controlling for confounding factors, the complication risk and 30-day ED visit risk increased through years, while the 30-day readmission risk did not have significant change. Risk of BDI also increased significantly (p = 0.03).

Conclusion

In an era of laparoscopy, the rate of IOC/CBD exploration during LC has significantly decreased, while BDI significantly increased.

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Acknowledgement

We acknowledge the biostatistical consultation and support from the Biostatistical Consulting Core at the School of Medicine, Stony Brook University.

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Authors and Affiliations

  1. Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, 100 Nichols Road, HSC T19, Stony Brook, NY, 11794, USA

    Maria S. Altieri, Nabeel Obeid, Mark Talamini & Aurora Pryor

  2. Department of Family, Population and 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

    Chencan Zhu

Authors
  1. Maria S. Altieri
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  2. Jie Yang
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  3. Nabeel Obeid
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  5. Mark Talamini
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  6. Aurora Pryor
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Correspondence to Maria S. Altieri.

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Disclosures

No industry or other external funding was used for this research. Dr. Pryor receives honoraria for speaking for Ethicon, Medtronic, Stryker, and Gore; is a consultant for Medicines Company, Merck, and Intuitive, and has ownership interest in Transenterix.

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Altieri, M.S., Yang, J., Obeid, N. et al. Increasing bile duct injury and decreasing utilization of intraoperative cholangiogram and common bile duct exploration over 14 years: an analysis of outcomes in New York State. Surg Endosc 32, 667–674 (2018). https://doi.org/10.1007/s00464-017-5719-2

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  • DOI: https://doi.org/10.1007/s00464-017-5719-2

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