Top

Surgical Endoscopy

Published in:

01-02-2018

Increasing bile duct injury and decreasing utilization of intraoperative cholangiogram and common bile duct exploration over 14 years: an analysis of outcomes in New York State

Authors: Maria S. Altieri, Jie Yang, Nabeel Obeid, Chencan Zhu, Mark Talamini, Aurora Pryor

Published in: Surgical Endoscopy | Issue 2/2018

Abstract

Introduction

During laparoscopic cholecystectomy (LC), common bile duct (CBD) visualization either directly or with cholangiography (IOC) is less routine. Cholangiography can be used to identify and possibly prevent bile duct injury (BDI), which is a dreaded complication of cholecystectomy. The purpose of our study was to evaluate the trend of IOC/CBD exploration and BDI during LC for benign disease.

Methods

A state-wide database (SPARCS) was used to identify all LC for benign biliary non-obstructive and obstructive disease between 2000 and 2014 in the state of New York. ICD-9 and CPT codes were used to identify IOC/CBD exploration and BDI. Multivariable logistic regression models were used in examining the linear trend in the risk of complication, 30-day readmission, 30-day ED visits, and BDI among all cholangiogram patients after controlling for possible confounding factors.

Results

During 2000–2014, 391,945 patients underwent laparoscopic cholecystectomy. The trend of IOC/CBD exploration performed significantly decreased for LC overall (12.37–10.44%, relative risk = 0.98, p <.0001) and particularly, in the outpatient setting (10.77–7.52%, relative risk = 0.96, p value <.0001). Among patients with IOC, overall complication rate, 30-day readmission rate, and 30-day ED visit rates increased. When looking at overall complication rate, there was an increase by about 4% per year (relative risk = 1.04, p value <.0001). After controlling for confounding factors, the complication risk and 30-day ED visit risk increased through years, while the 30-day readmission risk did not have significant change. Risk of BDI also increased significantly (p = 0.03).

Conclusion

In an era of laparoscopy, the rate of IOC/CBD exploration during LC has significantly decreased, while BDI significantly increased.

Truven Health Analytics (Thomson/Solucient), USA Procedure Volumes 2014

Calland JF, Tanaka K, Foley E et al (2001) Outpatient laparoscopic cholecystectomy: patient outcomes after implementation of a clinical pathway. Ann Surg 233(5):704–715CrossRefPubMedPubMedCentral

Shea JA, Berlin JA, Bachwich DR et al (1998) Indications for and outcomes of cholecystectomy: a comparison of the pre and postlaparoscopic eras. Ann Surg 227(3):343–350CrossRefPubMedPubMedCentral

Lillemoe KD, Lin JW, Talamini MA, Yeo CJ, Snyder DS, Parker SD (1999) Laparoscopic cholecystectomy as a “true” outpatient procedure: initial experience in 130 consecutive patients. J Gastrointest Surg 3(1):44–49CrossRefPubMed

Giger UF, Michel JM, Opitz I et al (2006) Risk factors for perioperative complications in patients undergoing laparoscopic cholecystectomy: analysis of 22,953 consecutive cases from the Swiss Association of Laparoscopic and Thoracoscopic Surgery database. J Am Coll Surg 203(5):723–728CrossRefPubMed

Halbert C, Pagkratis S, Yang J et al (2016) Beyond the learning curve: incidence of bile duct injuries following laparoscopic cholecystectomy normalize to open in the modern era. Surg Endosc 30(6):2239–2243CrossRefPubMed

Archer SB, Brown DW, Smith CD, Branum GD, Hunter JG (2001) Bile duct injury during laparoscopic cholecystectomy: results of a national survey. Ann Surg 234(4):549–558CrossRefPubMedPubMedCentral

Halbert C, Altieri MS, Yang J et al (2016) Long-term outcomes of patients with common bile duct injury following laparoscopic cholecystectomy. Surg Endosc 30(10):4294–4299CrossRefPubMed

Kern KA (1997) Malpractice litigation involving laparoscopic cholecystectomy. Cost, cause, and consequences. Arch Surg 132(4):392–397CrossRefPubMed

10.

Vezakis A, Davides D, Ammori BJ, Martin IG, Larvin M, McMahon MJ (2000) Intraoperative cholangiography during laparoscopic cholecystectomy. Surg Endosc 14(12):1118–1122CrossRefPubMed

11.

Kullman Borch K, Lindstrom E, Svanvik J, Anderberg B (1996) Value of routine intraoperative cholangiography in detecting aberrant bile ducts and bile duct injuries during laparoscopic cholecystectomy. Br J Surg 83(2):171–175CrossRefPubMed

12.

Buddingh KT, Weersma RK, Savenije RA, van Dam GM, Nieuwenhuijs VB (2011) Lower rate of major bile duct injury and increased intraoperative management of common bile duct stones after implementation of routine intraoperative cholangiography. J Am Coll Surg 213(2):267–274CrossRefPubMed

13.

Massarweh NN, Flum DR (2007) Role of intraoperative cholangiography in avoiding bile duct injury. J Am Coll Surg 204(4):656–664CrossRefPubMed

14.

Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR (1996) A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol 49(12):1373–1379CrossRefPubMed

15.

Mirizzi PL (1937) Operative cholangiography. Surg Gynecol Oncol 65:702–710

16.

Soper NJ, Brunt LM (1994) The case for routine operative cholangiography during laparoscopic cholecystectomy. Surg Clin North Am 74(4):953–959PubMed

17.

Flum DR, Dellinger EP, Cheadle A, Chan L, Koepsell T (2003) Intraoperative cholangiography and risk of common bile duct injury during cholecystectomy. JAMA 289(13):1639–1644CrossRefPubMed

18.

Ladocsi LT, Benitez LD, Filippone DR, Nance FC (1997) Intraoperative cholangiography in laparoscopic cholecystectomy: a review of 734 consecutive cases. Am Surg 63(2):150–156PubMed

19.

Woods MS, Traverso LW, Kozarek RA et al (1995) Biliary tract complications of laparoscopic cholecystectomy are detected more frequently with routine intraoperative cholangiography. Surg Endosc 9(10):1076–1080CrossRefPubMed

20.

Fletcher DR, Hobbs MS, Tan P et al (1999) Complications of cholecystectomy: risks of the laparoscopic approach and protective effects of operative cholangiography: a population-based study. Ann Surg 229(4):449–457CrossRefPubMedPubMedCentral

21.

Pucher PH, Brunt LM, Fanelli RD, Asbun HJ, Aggarwal R (2015) SAGES expert Delphi consensus: critical factors for safe surgical practice in laparoscopic cholecystectomy. Surg Endosc 29(11):3074–3085CrossRefPubMed

22.

Alvarez FA, de Santibanes M, Palavecino M et al (2014) Impact of routine intraoperative cholangiography during laparoscopic cholecystectomy on bile duct injury. Br J Surg 101(6):677–684CrossRefPubMed

23.

Giger U, Ouaissi M, Schmitz SF, Krähenbühl S, Krähenbühl L (2011) Bile duct injury and use of cholangiography during laparoscopic cholecystectomy. Br J Surg 98(3):391–396CrossRefPubMed

Title: Increasing bile duct injury and decreasing utilization of intraoperative cholangiogram and common bile duct exploration over 14 years: an analysis of outcomes in New York State
Authors: Maria S. Altieri
Jie Yang
Nabeel Obeid
Chencan Zhu
Mark Talamini
Aurora Pryor
Publication date: 01-02-2018
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 2/2018
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-017-5719-2

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Increasing bile duct injury and decreasing utilization of intraoperative cholangiogram and common bile duct exploration over 14 years: an analysis of outcomes in New York State

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 2/2018

Model to identify early-stage gastric cancers with deep invasion of submucosa based on endoscopy and endoscopic ultrasonography findings

Transoral robotic thyroidectomy: lessons learned from an initial consecutive series of 24 patients

Increased glycine-amidated hyocholic acid correlates to improved early weight loss after sleeve gastrectomy

Effect of patient-reported smoking status on short-term bariatric surgery outcomes

Surgical volume and conversion rate in laparoscopic hysterectomy: does volume matter? A multicenter retrospective cohort study

Comparative analysis of perioperative outcomes of robotic versus open transversus abdominis release