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Surgical Endoscopy

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01-05-2016

Major bile duct injury requiring operative reconstruction after laparoscopic cholecystectomy: a follow-on study

Authors: Patrick J. Worth, Taranjeet Kaur, Brian S. Diggs, Brett C. Sheppard, John G. Hunter, James P. Dolan

Published in: Surgical Endoscopy | Issue 5/2016

Abstract

Background

Bile duct injury (BDI) after laparoscopic cholecystectomy (LC) has significant cost impact and is a significant source of morbidity and mortality. We undertook a population-based assessment of the national experience with BDI between 2001 and 2011 and compared this to our report for the prior decade.

Methods

Using the nationwide inpatient sample (NIS) for 2001–2011, we identified patients who underwent LC or partial cholecystectomy, with and without biliary reconstruction. Data were analyzed using methods that accounted for the hierarchical, stratified random sampling of the NIS. Both univariate modeling and multivariate modeling were performed.

Results

LCs increased from 71.1 % in 2001 to 79.0 % in 2011 (p < 0.0001). Annual mortality decreased from 0.56 to 0.38 % (p = 0.002). In 2001, 0.11 % of LCs were associated with biliary reconstruction versus 0.09 % in 2011 (p = 0.15) with rates ranging from 0.08 to 0.12 %. The need for reconstruction was associated with an average in-hospital mortality rate of 4.4 %. Mortality rates from LC remained consistent across the study period (average mortality, 0.10 %, p = 0.57). Under multivariate analysis, admission to rural or urban non-teaching centers was associated with a decreased rate of injury; the majority of major BDIs were admitted from clinic or outpatient settings. These results are consistent with results from the prior decade. Neither emergent admission nor race was associated with increased odds of BDI, and this differs from our prior analysis.

Conclusion

LC continued to increase in utilization between 2001 and 2011. Although rates of BDI have decreased, the need for reconstruction continues to be associated with a significant mortality. In addition, mortality related to biliary reconstruction is also higher than previously published series and may reflect the complexity of managing biliary injury as well as the higher likelihood of these patients having comorbid conditions.

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Title: Major bile duct injury requiring operative reconstruction after laparoscopic cholecystectomy: a follow-on study
Authors: Patrick J. Worth
Taranjeet Kaur
Brian S. Diggs
Brett C. Sheppard
John G. Hunter
James P. Dolan
Publication date: 01-05-2016
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 5/2016
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-015-4469-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Major bile duct injury requiring operative reconstruction after laparoscopic cholecystectomy: a follow-on study

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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