Common Bile Duct Exploration in Decline: Majority of These Procedures Are Done in Non-teaching Hospitals in the Us.

BACKGROUND: Common bile duct (CBD) exploration used to be one of the relatively frequent procedures in armamentarium of the general surgeon. With raise of minimally invasive techniques one may expect diminished needs and fewer indications for that surgery.

OBJECTIVE: The purpose of this study was to determine nationwide trends of cholecystectomy and common bile duct exploration over 10 years period. In addition, this investigation was designed to evaluate utilization of these procedures in the teaching and non-teaching US Hospitals contributing to the National Inpatient Sample database.

METHODS: The National Inpatient Sample from the Healthcare Cost and Utilization Project was analyzed for 1997-2007 nationwide trends for open and laparoscopic cholecystectomy using ICD-9 procedure codes 51.22, 51.23 respectively, and exploration of CBD with and without CBD stone removal (51.41, 51.51). The data was subcategorized based on two main hospital characteristics: teaching or non-teaching hospitals. Analyzed data were weighted to provide national estimates. Statistical testing was performed using Z-test. The trends were studied using trendlines with R-square values as the coefficient of determination.

RESULTS: Number of cholecystectomies did not change over the observed period and ranged from 442,260 in 1997 to 429,805 in 2007 (R=0.0005). Open cholecystectomies declined from 138,116 in 1997 to 86,582 in 2007 (p<0.001), and number of laparoscopic cholecystectomies increased from 304,144 to 343,223 (p<0.01) during that period. Interestingly, more open cholecystectomies are done currently in teaching hospitals (52%) than in 1997 (44%). Number of CBD explorations showed declining trend from 25,984 in 1997 to 9,518 in 2007 (63%, y=-1503.2x + 25367, R= 0.9603). This trend was similar in CBD exploration with stone removal (13,990 to 5,385 respectively, 62% decline, z=14.369, p<0.001) and without: 11,994 in 1997 to 4,132 in 2007 (66% decline, z=3.684, p<0.001). There was one CBD exploration per 17 cholecystectomies in 1997 and one per 45 cholecystectomies in 2007. 63.4% of CBD explorations were done in nonteaching hospitals in 1997 versus 56.5% in 2007.

CONCLUSIONS: Although there was no change in total number of cholecystectomies performed annually between 1997 – 2007, number of laparoscopic procedures increased. During the same period, there was a steady decline in number of CBD explorations. This trend has been consistent in both teaching and non-teaching hospitals. Approximately 60% of choledochotomies are done in nonteaching hospitals. Because of declining exposure to problems related to CBD exploration, the future general surgeons might have insufficient experience in this procedure.

Session: Podium Presentation

Program Number: S014

« Return to SAGES 2010 abstract archive