Kenneth Bueltmann, MD, Marek Rudnicki, MD. Advocate Illinois Masonic Medical Center
Introduction: Intraoperative cholangiogram (IOC) remains a source of professional disagreement. Persistent speculation and a lack of cohesive evidence still surrounds the decision to choose the procedure over other available imaging modalities. It may be hypothesized that IOC utilization may not be favored when performing laparoscopic procedures and appears to have vulnerability to regional biases.
Methods: The Nationwide Inpatient Sample was queried for all cholecystectomies undertaken from 1998 to 2013. A subset (n=1,103,725) was created from those patients that were 18 years or older and cancer free and who underwent the laparoscopic procedure. From this data those patients who underwent IOC were subjected to statistical analysis using SAS Enterprise 6.1. Raw frequencies for outcome measures (mortality, length of stay, and total charges) were determined. Statistical evaluation of these groups were then computed using ANOVA and students t-tests where appropriate. Elixhauser’s methodology contained in HCUP’s comorbidity software was employed for coding and van Walraven method was used supplementary to generate a summary score. A combined surgical complications score was also employed.
Results: Mortality was found to be lower in the IOC+ group (0.47% vs 0.50%, p<.0001). Length of stay was higher in the IOC+ group (4.25 vs 4.07, p<.0001). Mean total charges were found to be higher in the IOC+ group ($32,141 vs $30,895, p<.0001). When controlling for age, gender, and race, multifactorial analysis of the comorbidity score revealed a weak correlation with utilization of IOC (OR=0.0033, 95% CI: .001-.005, p=.002) while IOC utilization was also found to be negatively correlated with the rate of complications (OR=-0.010, 95% CI: -0.012-0.007, p<.0001). The demographic data revealed patients in the US Southern census region are most likely to receive IOC (OR= 0.08, 95% CI: 0.078-.083, p<.0001). Rural/non-teaching (RNT) patients were also correlated with IOC (OR=0.06, 95% CI: 0.061-0.065, p<.0001) when compared regionally. Southern patients maintained the highest total charges of all rurally designated regions ($24,163 vs $15,931 in NE, p<.0001).
Conclusion: The utilization of IOC coincides with improved mortality but increased length of stay with higher average total charges. This choice of utilization is weakly correlated with patient comorbidity while demonstrating stronger reduction in the rate of surgical complications. Sothern RNT patients undergo IOC most frequently and do so at increased expense in comparison with the other US regions. Although IOC utilization appears to be decreasing, some clinical outcomes warrant its choice.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80615
Program Number: P656
Presentation Session: Poster (Non CME)
Presentation Type: Poster
