Bile duct injury after laparoscopic cholecystectomy in hospitals with and without surgical residency programs: is there a difference?

Abstract

Background

Laparoscopic cholecystectomy (LC) is a common surgical procedure performed by surgical residents under the supervision of attending surgeons. There is a perception that performance of LC in a facility with a surgical training program provides a safer environment due to the presence of an assistant surgeon. The aim of this study was to compare the rate of bile duct injury, conversion, and mortality between hospitals with surgical residency programs (Group I) and hospitals without surgical training programs (Group II).

Methods

ICD-9 diagnosis and procedure codes were used to extract and analyze LC procedures from the Florida State Inpatient Database from 1997 through 2006. Bile duct injury was indicated by the code for a biliary reconstruction procedure performed during the same admission. Hospitals with surgical training programs were identified by participation in the Electronic Residency Application Service (ERAS) and verified by contact with each hospital.

Results

Between 1997 and 2006 there were 234,220 LCs identified, with 17,596 performed by Group I and 213,906 performed by Group II. Rate of BDI for Group I and Group II was 0.24 and 0.26%, respectively (p = 0.71). There was a significant difference noted in emergency and urgent admission rates (65.6% for Group I vs. 77.2% for Group II; p < 0.001) and conversion (9.1% for Group I vs. 7.5% for Group II; p < 0.001). Mortality was 0.44% for Group I and 0.55% for Group II (p = 0.060).

Conclusion

Our data suggest that bile duct injury rates are not influenced by the presence of a surgical residency program. In addition, there was no significant difference in mortality for LC at hospitals with surgical residencies when compared to hospitals without surgical residencies. A significant difference was noted in admission type and conversion rate but this did not appear to affect the rate of bile duct injury.

Appendix A: Inclusion and exclusion diagnoses and procedures with associated ICD-9-CM codes

Inclusion

Laparoscopic cholecystectomy

• Open Cholecystectomy (51.22) and Conversion from Laparoscopic to Open Procedure (V64.4)

• Laparoscopic cholecystectomy (51.23)

• Laparoscopic partial cholecystectomy (51.24)

Biliary reconstruction

• Choledochoenterostomy (51.36)

• Anastomosis of the hepatic duct to the gastrointestinal tract (51.37)

• Other bile duct anastomosis (51.39)

• Simple suture of the common bile duct (51.71)

• Choledochoplasty (51.72)

• Repair of other bile ducts (51.79)

Exclusion

Diagnoses

• Malignant neoplasm of gallbladder and extrahepatic bile ducts (156.0, 156.1, 156.2, 156.8, 156.9)

• Malignant neoplasm of the pancreas (157.0, 157.1, 157.2, 157.3, 157.4, 157.8, and 157.9)

• Calculus of bile duct without mention of cholecystitis without (574.50) and with (574.51) mention of obstruction

• Obstruction of the bile duct except cystic duct without mention of calculus (576.2)

• Other specified disorders of biliary tract (adhesion, atrophy, cyst, hypertrophy, stasis, or ulcer) (576.8)

• Chronic pancreatitis (577.1)

• Cyst and pseudocyst of the pancreas (577.2)

• Other diseases of the pancreas (atrophy, calculus, cirrhosis, fibrosis, pancreatic infantilism or necrosis, or pancreaticolithiasis) (577.8)

• Unspecified disease of the pancreas (577.9)

• Complications of transplanted organ: liver (996.82)