Meredith Barrett, MD1, Dana Telem, MD, MPH1, Horacio Asbun, MD2, Michael Brunt, MD3. 1University of Michigan, 2Mayo Clinic Jacksonville, 3Washington University
Introduction: Bile duct injury (BDI) remains the most dreaded complication following cholecystectomy with serious repercussions for the surgeon, patient and entire healthcare system. In the absence of registries, the true incidence of BDI in the United States (US) remains unknown with most studies excluding large segments of the population or regions of the country. We aim to identify the incidence of BDI requiring operative intervention across all populations and regions in the US.
Methods: Utilizing the Truven Marketscan research database, 313,103 patients who underwent cholecystectomy in calendar years 2011 and 2012 were identified using ICD-9 procedure and diagnosis codes. Patients without 1-year of continuous enrollment in an insurance plan, those younger than 18, those with incomplete data and patients who carried a diagnosis of gastrointestinal or hepatobiliary malignancy were excluded. The resultant study population was 187,088 patients.Patients were then tracked for 1-year following procedure for BDI. BDI was identified by ICD-9 and CPT diagnosis and procedure codes for patients who subsequently underwent hepatectomy, hepaticojejunostomy, or other bile duct surgery.
Results: Out of the 187,088 patients who were included in the study, a total of 458 patients were identified with BDI (0.24%) that required operative intervention. The majority of injuries were identified at the time of the index procedure (n=329, 72%). Sixty-five injuries (14%) were identified within 30-days of surgery and the remainder (n=64, 14%) between 31 and 365 days following surgery. The overall operative complication rate within 30-days of surgery was 13.4% (n=25,163). The 3 most common complications occurring at the index procedure were intestinal disorders (1.2%), infection (1%) and shock (0.7%). The w most common complications identified at some point within 30-days of surgery included infection (2.7%), intestinal disorders (1.3%) and systemic inflammatory response syndrome (1.2%).
Conclusion: The major BDI rate requiring operative intervention remains at 0.24% in spite of increased experience with laparoscopic cholecystectomy. This incidence likely also underestimate the true BDI burden as it does not capture mortality, endoscopic and nonoperative treatment. Moreover, this procedure is associated with a 13% morbidity rate. These findings indicate an opportunity to improve the quality and safety of this operation. Continued attention to educational programs and techniques aimed at reducing patient harm and improving surgeon skill are imperative.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80628
Program Number: S010
Presentation Session: Biliary
Presentation Type: Podium