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THE EFFECT OF INTRAOPERATIVE BILE SPILLAGE ON OPERATIVE DECISIONS AND SURGICAL OUTCOMES IN LAPAROSCOPIC CHOLECYSTECTOMY

Young Lee, MD, MSc, Arjun Chandrasekaran, MD, MSMPh, Gonzalo Ausqui, MD, Connor McGinley, BS, Pratibha Vemulapalli, MD, FACS, Luca Milone, MD, PhD. The Brooklyn Hospital Center

Introduction: The effect of intraoperative bile spillage during laparoscopic cholecystectomy (LC) on operative time (OR time), length of stay (LOS), postoperative complication rates, and 30 day readmission rates was analyzed. Laparoscopic cholecystectomy is the gold standard operation for gallbladder disease in the United States.  Number of studies have shown that same day discharge in elective laparoscopic cholecystectomy is feasible and safe. Bile spillage during this procedure can be a common occurrence in teaching institutions, however, data on the effects of operative outcomes is lacking.

Methods: This is a retrospective study analyzing all of the laparoscopic cholecystectomies performed at The Brooklyn Hospital Center (TBHC), both emergent and elective, from 2016 – 2017. Patient data was collected on demographics, comorbidities, bile spillage, operative findings, complications, LOS, and 30 day readmission rates. Statistical analysis was performed using IMB SPSS Statistics v. 19.  Covaried analysis of variance (ANCOVA) was performed on continues variables and significance levels were calculated.  Pearson’s Chi Square significance level was calculated for all binomial variables.

Results: Of the 281 patients who underwent LC during this time period, intraoperative bile spillage was encountered in 32 patients. Interestingly, bile spillage was significantly more likely to be seen in elective cases over acute cases (11.8% vs 10.8 %, p < 0.05).  There was a statistically significant increase in OR time in cases where intraoperative bile spillage was encountered vs. cases where no bile spillage was encountered (146 vs. 124 min, p = 0.007). There was a significant increase in rate of conversion to open procedure when bile spillage was encountered (3.1% vs. 0.4%, p < 0.05). Drain placement rates increased, not surprisingly, when bile spillage was encountered (34.4% vs. 5.6%, p < 0.05).  There was no statistically significant difference in LOS between cases with bile spillage and cases without (2.47 days vs. 1.75days).  There was no significant increase in complication rate or 30 day readmission rates.

Conclusions: Intraoperative bile spillage significantly increases OR time, conversion to open procedure, and drain placement.  However, there was no significant effect observed of intraoperative bile spillage on length of stay, complication, and 30 day readmission rates.  Thus, intraoperative bile spillage appears to have little clinical significance on surgical outcomes. However it may have an impact on overall healthcare costs.  Larger prospective studies evaluating the effect of intraoperative bile spillage on LOS, OR time, complication rates, and 30 day readmission rates are needed to analyze these effects further.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 88335

Program Number: P083

Presentation Session: iPoster Session (Non CME)

Presentation Type: Poster

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