Maria Altieri, MD, Jie Yang, PhD, Chencan Zhu, MS, Nabeel Obeid, MD, Andrew Bates, MD, Mark Talamini, MD, Aurora Pryor, MD. Stony Brook Medical Center
Since the introduction of laparoscopy, laparoscopic cholecystectomy (LC) has become the most commonly performed general surgical procedure. Whereas during open cholecystectomy intra-operative cholangiogram (IOC) and common bile duct (CBD) exploration are easily performed, these techniques are more intricate during laparoscopy. These procedures can identify and possibly prevent CBD injury, which is a dreaded complication The purpose of our study was to evaluate the trend of IOC/CBD exploration and CBD injury during LC for benign disease.
A state-wide database (SPARCS) was used to identify all LC for benign biliary non-obstructive and obstructive disease between 2000-2014 in the state of New York. ICD-9 and CPT codes were used to identify IOC/CBD exploration and CBD injury. Multivariable logistic regression models were used in examining the linear trend in the risk of complication, readmission, and ED visits among all cholangiogram patients after controlling for possible confounding factors that were significantly associated based on chi-square tests. In these multivariable regression models any comorbidity/complication was used instead of specific ones because of limited number of events. Over the same time period, the trend in CBD injury was examined.
A total of 392,485 patients underwent LC during 2000-2014: 195,423(49.7%) inpatients and 197,062(50.2%) outpatients. The trend of IOC/CBD exploration performed between 2000-2014 significantly decreased for LC overall and particularly in the outpatient setting (11.87% to 10/27%, p<0.001). Overall complication rate, 30-day readmission rate and 30-day ED visit rates increased. When looking at overall complication rate, there was an increase by about 4 percent per year (relative risk=1.0440, p-value<.0001), as complication rate was 5.66% in 2000 and 9.62% in 2014. After controlling for confounding factors such as age, gender, race, region, insurance, inpatient, any comorbidity and any complication (not included for complication risk), their complication risk and 30-day ED visit risk increased through years, while the 30-day readmission risk did not have significant change. During 2000-2014, after controlling for aforementioned confounding factors, the non-admitted ED visit rate increased while the readmission rate did not change significantly. Hospital length of stay (HLOS) for patients with IOC/CBD decreased in this time period. Risk of CBD injury also increased significantly (p=0.04) (Figure 1).
In an era of laparoscopy, the rate of IOC/CBD exploration during LC has significantly decreased. In addition, the rate of complications and 30-day ED visits increased, although HLOS showed a decreasing trend. There is an increase in CBD injury in patients with and without IOC/CBD being performed.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79877
Program Number: S012
Presentation Session: Biliary
Presentation Type: Podium