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01-02-2020 | Cholecystectomy

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

Authors: Stephen O’Brien, David Wei, Neal Bhutiani, Mohan K. Rao, Stephen S. Johnston, Anuprita Patkar, Gary C. Vitale, Robert C. G. Martin II

Published in: Surgical Endoscopy | Issue 2/2020

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.

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Hall MJ, Schwartzman A, Zhang J, Liu X (2017) Ambulatory surgery data from Hospitals and Ambulatory Surgery Centers: United States, 2010. Natl Health Stat Rep 102:1–15

Halbert C, Pagkratis S, Yang J, Meng Z, Altieri MS, Parikh P, Pryor A, Talamini M, Telem DA (2016) Beyond the learning curve: incidence of bile duct injuries following laparoscopic cholecystectomy normalize to open in the modern era. Surg Endosc 30:2239–2243CrossRef

Törnqvist B, Strömberg C, Persson G, Nilsson M (2012) Effect of intended intraoperative cholangiography and early detection of bile duct injury on survival after cholecystectomy: population based cohort study. BMJ 345:e6457CrossRef

Waage A, Nilsson M (2006) Iatrogenic bile duct injury: a population-based study of 152 776 cholecystectomies in the Swedish Inpatient Registry. Arch Surg (Chicago, Ill: 1960) 141:1207–1213CrossRef

Booij KAC, de Reuver PR, van Dieren S, van Delden OM, Rauws EA, Busch OR, van Gulik TM, Gouma DJ (2018) Long-term impact of bile duct injury on morbidity, mortality, quality of life, and work related limitations. Ann Surg 268:143–150CrossRef

Barrett M, Asbun HJ, Chien HL, Brunt LM, Telem DA (2018) Bile duct injury and morbidity following cholecystectomy: a need for improvement. Surg Endosc 32:1683–1688CrossRef

Halbert C, Altieri MS, Yang J, Meng Z, Chen H, Talamini M, Pryor A, Parikh P, Telem DA (2016) Long-term outcomes of patients with common bile duct injury following laparoscopic cholecystectomy. Surg Endosc 30:4294–4299CrossRef

Alexander HC, Bartlett AS, Wells CI, Hannam JA, Moore MR, Poole GH, Merry AF (2018) Reporting of complications after laparoscopic cholecystectomy: a systematic review. HPB 20:786–794CrossRef

Andersson R, Eriksson K, Blind P-J, Tingstedt B (2008) Iatrogenic bile duct injury—a cost analysis. HPB 10:416–419CrossRef

10.

Roy PG, Soonawalla ZF, Grant HW (2009) Medicolegal costs of bile duct injuries incurred during laparoscopic cholecystectomy. HPB 11:130–134CrossRef

11.

Premier Inc (2018) Premier healthcare database white paper: data that informs and performs. Premier applied sciences. Premier Inc, Charlotte

12.

Tornqvist B, Stromberg C, Akre O, Enochsson L, Nilsson M (2015) Selective intraoperative cholangiography and risk of bile duct injury during cholecystectomy. Br J Surg 102:952–958CrossRef

13.

Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383CrossRef

14.

Austin PC (2009) Using the standardized difference to compare the prevalence of a binary variable between two groups in observational research. Commun Stat 38:1228–1234CrossRef

15.

Morgenstern L, Wong L, Berci G (1992) Twelve hundred open cholecystectomies before the laparoscopic era. A standard for comparison. Arch Surg (Chicago, Ill: 1960) 127:400–403CrossRef

16.

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

17.

Bailey RW, Zucker KA, Flowers JL, Scovill WA, Graham SM, Imbembo AL (1991) Laparoscopic cholecystectomy Experience with 375 consecutive patients. Ann Surg 214:531–540 discussion 540-531 CrossRef

18.

Martin D, Uldry E, Demartines N, Halkic N (2016) Bile duct injuries after laparoscopic cholecystectomy: 11-year experience in a tertiary center. Bioscience trends 10:197–201CrossRef

19.

Fong ZV, Pitt HA, Sicklick JK, Strasberg SM, Loehrer AP, Talamini MA, Lillemoe KD, Chang DC (2017) Cost of bile duct injury: surgical vs endoscopic management. J Am Coll Surg 225:S113CrossRef

20.

Chun K (2014) Recent classifications of the common bile duct injury. Korean J Hepato-Biliary-Pancreatic Surg 18:69–72CrossRef

21.

Wu J-S, Peng C, Mao X-H, Lv P (2007) Bile duct injuries associated with laparoscopic and open cholecystectomy: sixteen-year experience. World J Gastroenterol 13:2374–2378CrossRef

22.

Ahmad NZ, Byrnes G, Naqvi SA (2008) A meta-analysis of ambulatory versus inpatient laparoscopic cholecystectomy. Surg Endosc 22:1928–1934CrossRef

23.

Alı OP, Ibis AC, Gurtekin B (2017) Financial aspects of bile duct injuries. Med Sci Monit 23:5264–5270CrossRef

24.

Jaunoo SS, Mohandas S, Almond LM (2010) Postcholecystectomy syndrome (PCS). Int J Surg 8:15–17CrossRef

25.

Girometti R, Brondani G, Cereser L, Como G, Del Pin M, Bazzocchi M, Zuiani C (2010) Post-cholecystectomy syndrome: spectrum of biliary findings at magnetic resonance cholangiopancreatography. Br J Radiol 83:351–361CrossRef

26.

Hugh TB (2002) Laparoscopic bile duct injury: some myths. ANZ J Surg 72:164–167CrossRef

27.

Sicklick JK, Camp MS, Lillemoe KD, Melton GB, Yeo CJ, Campbell KA, Talamini MA, Pitt HA, Coleman J, Sauter PA, Cameron JL (2005) Surgical management of bile duct injuries sustained during laparoscopic cholecystectomy: perioperative results in 200 patients. Ann Surg 241:786–792 discussion 793-785 CrossRef

28.

Ford JA, Soop M, Du J, Loveday BP, Rodgers M (2012) Systematic review of intraoperative cholangiography in cholecystectomy. Br J Surg 99:160–167CrossRef

29.

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

30.

Wakabayashi G, Iwashita Y, Hibi T, Takada T, Strasberg SM, Asbun HJ, Endo I, Umezawa A, Asai K, Suzuki K, Mori Y, Okamoto K, Pitt HA, Han H-S, Hwang T-L, Yoon Y-S, Yoon D-S, Choi I-S, Huang WS-W, Giménez ME, Garden OJ, Gouma DJ, Belli G, Dervenis C, Jagannath P, Chan ACW, Lau WY, Liu K-H, Su C-H, Misawa T, Nakamura M, Horiguchi A, Tagaya N, Fujioka S, Higuchi R, Shikata S, Noguchi Y, Ukai T, Yokoe M, Cherqui D, Honda G, Sugioka A, Santibañes E, Supe AN, Tokumura H, Kimura T, Yoshida M, Mayumi T, Kitano S, Inomata M, Hirata K, Sumiyama Y, Inui K, Yamamoto M (2018) Tokyo Guidelines 2018: surgical management of acute cholecystitis: safe steps in laparoscopic cholecystectomy for acute cholecystitis (with videos). J Hepato-Biliary-Pancreat Sci 25:73–86CrossRef

31.

Sanford DE, Strasberg SM (2014) A simple effective method for generation of a permanent record of the Critical View of Safety during laparoscopic cholecystectomy by intraoperative “doublet” photography. J Am Coll Surg 218:170–178CrossRef

32.

Chen CB, Palazzo F, Doane SM, Winter JM, Lavu H, Chojnacki KA, Rosato EL, Yeo CJ, Pucci MJ (2017) Increasing resident utilization and recognition of the critical view of safety during laparoscopic cholecystectomy: a pilot study from an academic medical center. Surg Endosc 31:1627–1635CrossRef

Title: Adverse outcomes and short-term cost implications of bile duct injury during cholecystectomy
Authors: Stephen O’Brien
David Wei
Neal Bhutiani
Mohan K. Rao
Stephen S. Johnston
Anuprita Patkar
Gary C. Vitale
Robert C. G. Martin II
Publication date: 01-02-2020
Publisher: Springer US
Keyword: Cholecystectomy
Published in: Surgical Endoscopy / Issue 2/2020
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-019-06809-8

At a glance: The STEP trials

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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