Bile Duct Injury After Laparoscopic Cholecystectomy in Hospitals with and Without Surgical Training Programs. Is There a Difference?

Introduction: Laparoscopic cholecystectomy (LC) is one of the most common surgical procedures performed by non academic surgeons as well as general surgery residents, under the supervision of academic surgeons. Bile duct injury is a catastrophic complication of this procedure. There is a general perception that performance of LC in a facility with a surgical training program offers a safer environment due to the presence of an assistant surgeon.

Objective: To compare the rate of bile duct injury, conversion and overall mortality between hospitals with surgical training programs (Group I), and hospitals without surgical training programs (Group II) after LC.

Methods: Methods: Using the Florida State Inpatient Database we extracted and analyzed data for LC and conversion from LC to open cholecystectomy (OC) during the years 1997 thru 2006. Bile duct injury was indicated by a biliary reconstruction procedure performed during the same admission. Hospitals with surgical training programs were identified by participation in the National Resident Match Program (NRMP) and verified by contact with the hospitals Graduate Medical Education Office and/or Department of Surgery. Additional factors examined included age, gender, admission diagnosis and admission type, length of stay, conversions rate and mortality.

Results: Between 1997 and 2006, there were a total of 234,220 LC performed with 17,596 performed at Group I hospitals and 213,906 performed at Group II hospitals. Overall, the rate of BDI between Group I and Group II was 0.24% and 0.26% respectively (p=0.71). The majority of patients had cholecystitis as the indication for surgery (91.1% in Group 1 and 95.5% in Group II; p=0.001). There was also a significant difference between the two groups in terms of emergency and urgent admission rates (65.6% for Group I vs. 77.2% for Group II; p=<0.001) as well as conversion to OC (9.1% for Group I vs. 7.5% for Group II; p=<0.001). Median length of stay was similar between the two groups. Mortality was 0.44% for Group I and 0.55% for Group II (p=0.06).

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

Session: Podium Presentation

Program Number: S021

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