Skip to main content

Advertisement

SpringerLink
Log in

Performance of the American College of Surgeons National Surgical Quality Improvement calculator for early postoperative outcomes following bile duct repair hepaticojejunostomy

  • Original Article
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Purpose

A Roux-en-Y hepaticojejunostomy (HJ) is the preferred method for repairing bile duct injuries (BDIs). The American College of Surgeons (ACS) established the National Surgical Quality Improvement Program (NSQIP) online risk calculator to predict risks for morbidity and mortality. The objective of the study is to assess the use of the ACS NSQIP calculator for patients undergoing HJ for BDI repairs outside the NSQIP cohort.

Methods

An IRB-approved retrospective study of Bismuth-Strasberg type E BDI HJ (2008-2020) was performed. Clinical data was introduced in the NSQIP calculator, and morbidity and mortality were determined. Perioperative risk factors were obtained. Comparisons of postoperative complications and NSQIP-predicted complication rate were carried out.

Results

Eighty-two patients were included (age: 42.2 ± 15.7 years; 81% female; BMI 27.1 ± 4.4 kg/m2). The most common injury was E4 (36.3%). A total of 40.2% patients had a 30-day complication. Mortality was 2.4%. Preoperative sepsis and high body mass index (p = 0.01) were significantly related to complications (p = 0.01) (univariate analysis). Older age (p = 0.01) and higher ASA class (p = 0.02) were significantly related to mortality (univariate analysis). None was statistically significant in multivariate analysis. Comparison between morbidity and mortality and the calculated NSQIP was not statistically significant. Postoperative mortality had a statistically significant trend (C-value = 0.72, p = 0.055).

Conclusion

Preoperative sepsis, high body mass index, age, and ASA classification were associated with worse outcomes in HJ BDI repair. The ACS NSQIP calculator did not have a good performance in a population outside the NSQIP data. Further larger studies will need to corroborate these results.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data availability

Yes.

References

  1. Gouma DJ, Go PM (1994) Bile duct injury during laparoscopic and conventional cholecystectomy. J Am Coll Surg 178(3):229–233

    CAS  PubMed  Google Scholar 

  2. Tantia O, Jain M, Khanna S, Sen B (2008) Iatrogenic biliary injury: 13,305 cholecystectomies experienced by a single surgical team over more than 13 years. Surg Endosc 22(4):1077–1086

    Article  CAS  Google Scholar 

  3. Dominguez-Rosado I, Mercado MA, Kauffman C, Ramirez-del Val F, Elnecavé-Olaiz A, Zamora-Valdés D (2014) Quality of life in bile duct injury: 1-, 5-, and 10-year outcomes after surgical repair. J Gastrointest Surg 18(12):2089–2094

    Article  Google Scholar 

  4. Flores-Rangel GA, Chapa-Azuela O, Rosales AJ, Roca-Vasquez C, Böhm-González ST (2018) Quality of life in patients with background of iatrogenic bile duct injury. World J Surg 42(9):2987–2991

    Article  Google Scholar 

  5. Bismuth H, Majno PE (2001) Biliary strictures: classification based on the principles of surgical treatment. World J Surg 25(10):1241–1244

    Article  CAS  Google Scholar 

  6. Strasberg SM, Hertl M, Soper NJ (1995) An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 180(1):101–125

    CAS  PubMed  Google Scholar 

  7. Mercado MA, Dominguez I (2011) Classification and management of bile duct injuries. World J Gastrointest Surg (4):43–48

  8. Díaz-Martínez J, Chapa-Azuela O, Roldan-García JA, Flores-Rangel GA (2020) Bile duct injuries after cholecystectomy, analysis of constant risk. Annals of hepato-biliary-pancreatic surgery 24(2):150–155

    Article  Google Scholar 

  9. Mercado MA, Franssen B, Dominguez I, Arriola-Cabrera JC, Ramirez-Del Val F, Elnecave-Olaiz A et al (2011) Transition from a low: to a high-volume centre for bile duct repair: changes in technique and improved outcome. HPB (Oxford) (11):767–773

  10. Sicklick JK, Camp MS, Lillemoe KD, Melton GB, Yeo CJ, Campbell KA et al (2005) Surgical management of bile duct injuries sustained during laparoscopic cholecystectomy: perioperative results in 200 patients. Ann Surg (5):786–792 discussion 93-5

  11. Walsh RM, Henderson JM, Vogt DP, Brown N (2007) Long-term outcome of biliary reconstruction for bile duct injuries from laparoscopic cholecystectomies. Surgery 142(4):450–456 discussion 6-7

    Article  Google Scholar 

  12. Cho JY, Baron TH, Carr-Locke DL, Chapman WC, Costamagna G, de Santibanes E et al (2018) Proposed standards for reporting outcomes of treating biliary injuries. HPB (Oxford) (4):370–378

  13. Bilimoria KY, Liu Y, Paruch JL, Zhou L, Kmiecik TE, Ko CY et al (2013) Development and evaluation of the universal ACS NSQIP surgical risk calculator: a decision aid and informed consent tool for patients and surgeons. J Am Coll Surg 217(5):833-42.e1-3

    Article  Google Scholar 

  14. Liu Y, Cohen ME, Hall BL, Ko CY, Bilimoria KY (2016) Evaluation and enhancement of calibration in the American College of Surgeons NSQIP surgical risk calculator. J Am Coll Surg 223(2):231–239

    Article  Google Scholar 

  15. Kneuertz PJ, Pitt HA, Bilimoria KY, Smiley JP, Cohen ME, Ko CY, Pawlik TM (2012) Risk of morbidity and mortality following hepato-pancreato-biliary surgery. J Gastrointest Surg 16(9):1727–1735

    Article  Google Scholar 

  16. Pitt HA, Kilbane M, Strasberg SM, Pawlik TM, Dixon E, Zyromski NJ et al (2009) ACS-NSQIP has the potential to create an HPB-NSQIP option. HPB (Oxford) 11(5):405–413

    Article  Google Scholar 

  17. Beal EW, Lyon E, Kearney J, Wei L, Ethun CG, Black SM, Dillhoff M, Salem A, Weber SM, Tran TB, Poultsides G, Shenoy R, Hatzaras I, Krasnick B, Fields RC, Buttner S, Scoggins CR, Martin RCG, Isom CA, Idrees K, Mogal HD, Shen P, Maithel SK, Pawlik TM, Schmidt CR (2017) Evaluating the American College of Surgeons National Surgical Quality Improvement project risk calculator: results from the U.S. Extrahepatic Biliary Malignancy Consortium. HPB (Oxford) 19(12):1104–1111

    Article  Google Scholar 

  18. Ismael HN, Cox S, Cooper A, Narula N, Aloia T (2017) The morbidity and mortality of hepaticojejunostomies for complex bile duct injuries: a multi-institutional analysis of risk factors and outcomes using NSQIP. HPB (Oxford) 19(4):352–358

    Article  Google Scholar 

  19. Martinez-Mier G, Luna-Ortiz HJ, Hernandez-Herrera N, Zilli-Hernandez S (2018) Lajud-Barquin FA. [Factores de riesgo asociados a las complicaciones y a la falla terapeutica en las reconstrucciones de lesiones de via biliar secundarias a colecistectomia]. Cir Cir 86(6):491–498

    PubMed  Google Scholar 

  20. Martínez-Mier G, Moreno-Ley PI, Mendez-Rico D (2020) Factors associated with patency loss and actuarial patency rate following post-cholecystectomy bile duct injury repair: long-term follow-up. Langenbecks Arch Surg 405(7):999–1006

    Article  Google Scholar 

  21. Cho JY, Jaeger AR, Sanford DE, Fields RC, Strasberg SM (2015) Proposal for standardized tabular reporting of observational surgical studies illustrated in a study on primary repair of bile duct injuries J. Am Coll Surg 221(3):678–688

    Article  Google Scholar 

  22. Tang ST, Yang Y, Wang Y, Mao YZ, Li SW, Tong QS et al (2015) Laparoscopic choledochal cyst excision, hepaticojejunostomy, and extracorporeal Roux-en-Y anastomosis: a technical skill and intermediate-term report in 62 cases. Surg Endosc (2):416–422

  23. Jackson N, Dugan A, Davenport D, Daily M, Shah M, Berger J et al (2016) Risk factors for increased resource utilization and critical care complications in patients undergoing hepaticojejunostomy for biliary injuries. HPB (Oxford) 18(9):712–717

    Article  Google Scholar 

  24. Rueda-De-Leon A, Dominguez-Rosado I, Contreras AG, Vilatoba M, Mercado MA (2020) Disparities in bile duct injury care. Surg Endosc 34(3):1324–1329

    Article  Google Scholar 

  25. Cuendis-Velazquez A, Trejo-Avila M, Bada-Yllan O, Cardenas-Lailson E, Morales-Chavez C, Fernandez-Alvarez L et al (2019) A new era of bile duct repair: robotic-assisted versus laparoscopic hepaticojejunostomy. J Gastrointest Surg. 23(3):451–459

    Article  Google Scholar 

  26. Martínez-Mier G, Moreno-Ley PI, Esquivel-Torres S, Gonzalez-Grajeda JL, Mendez-Rico D (2020) Differences in post-cholecystectomy bile duct injury care: a comparative analysis of 2 different health-care public institutions in a low- and middle-income country: Southeast Mexico. Dig Surg Aug 23:1–8. https://doi.org/10.1159/000509706 Epub ahead of print

    Article  Google Scholar 

  27. Schreuder AM, Nunez Vas BC, Booij KAC, van Dieren S, Besselink MG, Busch OR et al (2020) Optimal timing for surgical reconstruction of bile duct injury: meta-analysis. BJS Open 4(5):776–786

    Article  CAS  Google Scholar 

Download references

Authors´ contributions

Gustavo Martinez-Mier: design of the work, data acquisition, data analysis, interpretation of the data, manuscript draft, critical revision of the manuscript, and final approval of the manuscript. Pedro I. Moreno-Ley: data acquisition, data analysis, interpretation of the data, manuscript draft, critical revision of the manuscript, and final approval of the manuscript. Daniel Mendez-Rico: data acquisition, data analysis, critical revision of the manuscript, and final approval of the manuscript. Fortino Gonzalez-Gonzalez: data acquisition, data analysis, interpretation of the data, and final approval of the manuscript. Andrea Nachon-Acosta: data acquisition, data analysis, interpretation of the data, and final approval of the manuscript.

Author information

Authors and Affiliations

  1. Organ Transplantation and General Surgery, IMSS UMAE Hospital de Especialidades 14 “Adolfo Ruiz Cortines”, Cuauhtemoc S/N Formando Hogar, 91897, Veracruz, Veracruz, Mexico

    Gustavo Martínez-Mier & Pedro I. Moreno-Ley

  2. Organ Transplantation and General Surgery, SESVER Hospital de Alta Especialidad “Virgilio Uribe” 20 de Noviembre 1074 Centro, 91700, Veracruz, Veracruz, Mexico

    Gustavo Martínez-Mier & Pedro I. Moreno-Ley

  3. Corporativo San Gabriel, Alacio Perez 928-314, Fracc. Zaragoza, 91910, Veracruz, Veracruz, Mexico

    Gustavo Martínez-Mier

  4. General Surgery, IMSS UMAE Hospital de Especialidades 14 “Adolfo Ruiz Cortines”, Cuauhtemoc S/N Formando Hogar, 91897, Veracruz, Veracruz, Mexico

    Daniel Mendez-Rico & Andrea Nachón-Acosta

  5. General Surgery, SESVER Hospital de Alta Especialidad “Virgilio Uribe” 20 de Noviembre 1074 Centro, 91700, Veracruz, Veracruz, Mexico

    Fortino Gonzalez-Gonzalez

Authors
  1. Gustavo Martínez-Mier
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pedro I. Moreno-Ley
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Daniel Mendez-Rico
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fortino Gonzalez-Gonzalez
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andrea Nachón-Acosta
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gustavo Martínez-Mier.

Ethics declarations

Ethics approval

IRB committees (IMSS: R-3001-2015-54 and SESVER: R:18/01/2012).

Consent to participate

Signed by patients.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Martínez-Mier, G., Moreno-Ley, P.I., Mendez-Rico, D. et al. Performance of the American College of Surgeons National Surgical Quality Improvement calculator for early postoperative outcomes following bile duct repair hepaticojejunostomy. Langenbecks Arch Surg 406, 1935–1942 (2021). https://doi.org/10.1007/s00423-021-02133-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-021-02133-9

Keywords

Search

Navigation