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01-03-2013 | 2012 SSAT Plenary Presentation

Is Routine Intraoperative Cholangiogram Necessary in the Twenty-First Century? A National View

Authors: Elizaveta Ragulin-Coyne, Elan R. Witkowski, Zeling Chau, Sing Chau Ng, MS, Heena P. Santry, Mark P. Callery, Shimul A. Shah, Jennifer F. Tseng

Published in: Journal of Gastrointestinal Surgery | Issue 3/2013

Abstract

Introduction

Intraoperative cholangiogram (IOC) can define biliary ductal anatomy. Routine IOC has been proposed previously. However, current surgeon IOC utilization practice patterns and outcomes are unclear.

Methods

Nationwide Inpatient Sample 2004–2009 was queried for patients with acute biliary disease undergoing cholecystectomy (CCY). Analyses only included surgeons performing ≥10 CCY/year. We dichotomized surgeons into a routine IOC group vs. selective. Outcomes included bile duct injury, complications, mortality, length of stay, and cost.

Results

Of the nonweighted patients, 111,815 underwent CCY. A total of 4,740 actual surgeon yearly volumes were examined. On average, each surgeon performed 23.6 CCYs and 7.9 IOCs annually, using IOC in 33 % of cases. The routine IOC group used IOC for 96 % of cases, whereas selective IOC group used IOC ∼25 % of the time. Routine IOC surgeons had no difference in mortality (0.4 %) or rate of bile duct injury (0.25 vs. 0.26 %), but higher overall complications (7.3 vs. 6.8 %, p = 0.04). Patients of routine IOC surgeons received more additional procedures and incurred higher costs.

Conclusion

Routine IOC does not decrease the rate of bile duct injury, but is associated with significant added cost. Surgeons’ routine use of IOC is correlated with increased rates of postsurgical procedures, and is associated with increased overall complications. These data suggest routine IOC may not improve outcomes.

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Title: Is Routine Intraoperative Cholangiogram Necessary in the Twenty-First Century? A National View
Authors: Elizaveta Ragulin-Coyne
Elan R. Witkowski
Zeling Chau
Sing Chau Ng, MS
Heena P. Santry
Mark P. Callery
Shimul A. Shah
Jennifer F. Tseng
Publication date: 01-03-2013
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 3/2013
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-012-2119-8

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Is Routine Intraoperative Cholangiogram Necessary in the Twenty-First Century? A National View

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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