Andrew Lambour, MD, Karissa Tauber, Jesse Columbo, MD, Byron F Santos, MD. Dartmouth-Hitchcock Medical Center
Background: The benefits of intra-operative cholangiography (IOC) during laparoscopic cholecystectomy have been widely studied. The impact on readmissions has yet to be fully determined. We hypothesized that surgeon confidence in lack of bile duct injury or retained stones afforded with IOC could lead to a reduced readmission rate.
Methods: We reviewed all laparoscopic and laparoscopic converted to open cholecystectomy cases from September 2013 to August 2016 (n=772, mean age=54, %female=68%). A comparison of cases performed with IOC (LC+IOC, n=428) was made to those without IOC (LC alone, n=344). The primary outcome of interest was 30-day readmissions. Readmissions were further evaluated to determine the cause for admission, the likelihood of being related to surgery, and the subsequent length of stay (LOS). Secondary outcomes include 30-day mortality, 90-day major complications, 90-day minor complications, and 90-day bile duct injury. Major complications were defined as one of the following: bleeding requiring an intervention, abscess, pancreatitis, bowel injury, or bile duct injury. Minor complications were defined as any post-operative problem requiring re-evaluation or a change in management.
Results: The 30-day readmission rate was 4.2% (n=18) for LC+IOC compared to 7.8% (n=27) for LC alone. The LC alone group was 50% more likely to be readmitted with an OR 0.50 [95%CI 0.26-0.94], p=0.032. Similarly, readmissions related to surgery were higher in the LC alone group (14 vs. 22, 0.47 [0.23-0.96], p=0.041). Of these 36 patients, 24 were readmitted with a diagnosis of abdominal pain and to rule out or manage a bile leak or retained stone, 5 for infectious causes, 3 for respiratory issues, 1 for an NSTEMI, 1 for an incarcerated hernia, and 1 for management of a carcinoma. The median LOS from readmissions related to surgery was 4 (IQR 7) for LC+IOC and 5 (IQR 3) for LC alone.
Both groups were evenly matched with regards to patient characteristics. There was a significantly increased risk of 90-day minor complications in the LC alone group (27 vs. 40, 0.55 [0.32-0.95], p=0.009). There were no statistically significant differences in any of the other secondary outcomes, however, these events occurred more frequently in the LC alone group.
Conclusions: We found that 30-day readmissions were significantly increased in the LC alone group. Furthermore, the majority of these readmissions were primarily for abdominal pain and to rule out or manage a bile leak or retained stone. An added benefit of routine IOC may be a reduction in readmission rates.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87322
Program Number: S118
Presentation Session: Residents/Fellows Session
Presentation Type: ResFel