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Surgical Endoscopy

, Volume 34, Issue 2, pp 628–635 | Cite as

Adverse outcomes and short-term cost implications of bile duct injury during cholecystectomy

  • Stephen O’Brien
  • David Wei
  • Neal Bhutiani
  • Mohan K. Rao
  • Stephen S. Johnston
  • Anuprita Patkar
  • Gary C. Vitale
  • Robert C. G. MartinIIEmail author
Article

Abstract

Background

Bile duct injury (BDI) is an uncommon but major complication of cholecystectomy that has a poorly defined magnitude of effect on hospital costs. This study sought to calculate the healthcare costs, length of stay, and discharge status associated with bile duct injury in patients undergoing cholecystectomy in the United States.

Methods

The Premier Healthcare Database, which comprises hospital-billing records from over 700 hospitals in the United States, was queried for all patients undergoing cholecystectomy between January 2010 and March 2018. BDI was defined by ICD-9-CM and ICD-10-CM codes. Patient demographics, clinical characteristics, and operative information were extracted. Hospital costs, length of stay, and discharge status were compared between BDI and non-BDI patients. Propensity score matching was used to minimize confounding factors. Multivariable regression models were used to estimate the association between BDI and the outcomes variables.

Results

A total of 1,168,288 cholecystectomies were identified. BDI occurred in 878 patients (0.08%). Laparoscopy was the most common approach (> 95%). The majority of BDI occurred during inpatient admissions (71.0%). BDI patients had higher index admission hospital costs ($18,771 vs. $12,345, p < 0.0001), increased rate of discharge to an institutional post-acute care facility (odds ratio 3.89, 95% CI 2.92–5.19, p < 0.0001), and increased risk of readmission within 30 days after discharge (odds ratio 1.86, 95% CI 1.52–2.28, p < 0.0001), compared to patients without BDI. Among inpatient cholecystectomies, BDI was associated with increased length of stay (8.6 days vs. 4.8 days, p < 0.0001).

Conclusion

BDI is associated with significantly increased hospital costs, length of stay, 30-day readmission, and discharge to an institutional post-acute care facility.

Keywords

Cholecystectomy Complication Cost 

Notes

Acknowledgements

The authors acknowledge data analytic support by Bidusee Ray from Mu Sigma.

Funding

No outside funding was obtained for this article.

Compliance with ethical standards

Disclosure

Dr. Wei and Mr. Johnson are employees of and have an equity interest in Johnson & Johnson, New Brunswick, NJ, USA. Dr. Patkar is an employee of and has an equity interest in Ethicon, Somerville, NJ, USA. Drs. O’Brien, Bhutiani, Rao, Vitale, and Martin have no conflicts of interest or financial ties to disclose.

Supplementary material

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Supplementary material 1 (DOCX 12 kb)
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Supplementary material 2 (DOCX 13 kb)
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Supplementary material 3 (DOCX 13 kb)
464_2019_6809_MOESM4_ESM.docx (14 kb)
Supplementary material 4 (DOCX 13 kb)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Hiram C. Polk Jr, MD Department of SurgeryUniversity of LouisvilleLouisvilleUSA
  2. 2.Epidemiology, Medical DevicesJohnson & JohnsonNew BrunswickUSA
  3. 3.Department of SurgeryBaptist HealthMadisonvilleUSA
  4. 4.Franchise Health Economics and Market AccessEthiconSomervilleUSA
  5. 5.Division of Surgical Oncology, The Hiram C. Polk, Jr., MD Department of SurgeryUniversity of Louisville School of MedicineLouisvilleUSA

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