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Major bile duct injury requiring operative reconstruction after laparoscopic cholecystectomy: a follow-on study

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Abstract

Background

Bile duct injury (BDI) after laparoscopic cholecystectomy (LC) has significant cost impact and is a significant source of morbidity and mortality. We undertook a population-based assessment of the national experience with BDI between 2001 and 2011 and compared this to our report for the prior decade.

Methods

Using the nationwide inpatient sample (NIS) for 2001–2011, we identified patients who underwent LC or partial cholecystectomy, with and without biliary reconstruction. Data were analyzed using methods that accounted for the hierarchical, stratified random sampling of the NIS. Both univariate modeling and multivariate modeling were performed.

Results

LCs increased from 71.1 % in 2001 to 79.0 % in 2011 (p < 0.0001). Annual mortality decreased from 0.56 to 0.38 % (p = 0.002). In 2001, 0.11 % of LCs were associated with biliary reconstruction versus 0.09 % in 2011 (p = 0.15) with rates ranging from 0.08 to 0.12 %. The need for reconstruction was associated with an average in-hospital mortality rate of 4.4 %. Mortality rates from LC remained consistent across the study period (average mortality, 0.10 %, p = 0.57). Under multivariate analysis, admission to rural or urban non-teaching centers was associated with a decreased rate of injury; the majority of major BDIs were admitted from clinic or outpatient settings. These results are consistent with results from the prior decade. Neither emergent admission nor race was associated with increased odds of BDI, and this differs from our prior analysis.

Conclusion

LC continued to increase in utilization between 2001 and 2011. Although rates of BDI have decreased, the need for reconstruction continues to be associated with a significant mortality. In addition, mortality related to biliary reconstruction is also higher than previously published series and may reflect the complexity of managing biliary injury as well as the higher likelihood of these patients having comorbid conditions.

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Acknowledgments

Dr. Dolan’s authorship in this publication was supported by the Oregon Clinical and Translational Research Institute (OCTRI), and a Grant (No. UL1TR000128) from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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Authors and Affiliations

  1. Department of Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Mackenzie Hall L223A, Portland, OR, 97239, USA

    Patrick J. Worth, Taranjeet Kaur, Brian S. Diggs, Brett C. Sheppard, John G. Hunter & James P. Dolan

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  1. Patrick J. Worth
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  2. Taranjeet Kaur
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  3. Brian S. Diggs
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  4. Brett C. Sheppard
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Corresponding author

Correspondence to James P. Dolan.

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Disclosures

Patrick J. Worth, MD, Taranjeet Kaur, MBBS, Brian S. Diggs, PhD, Brett C. Sheppard, MD, MS, John G. Hunter, MD, James P. Dolan, MD, MCR, have no conflicts of interest or financial ties to disclose.

Appendix: Exclusion diagnoses and procedures with associated ICD-9-CM

Appendix: Exclusion diagnoses and procedures with associated ICD-9-CM

Exclusion

Diagnoses

  • Malignant neoplasm of the pancreas (157.0, 157.1, 157.2, 157.3, 157.4, 157.8, and 157.9).

  • Malignant neoplasm of gallbladder and extrahepatic bile ducts (156.0, 156.1, 156.2, 156.8, 156.9)

  • Chronic pancreatitis (577.1)

  • Cyst and pseudocyst of the pancreas (577.2)

  • Other diseases of the pancreas (atrophy, calculus, cirrhosis, fibrosis, pancreatic infantilism or necrosis, or pancreaticolithiasis) (577.8)

  • Unspecified disease of the pancreas (577.9)

  • Obstruction of the bile duct except cystic duct without mention of calculus (576.2)

  • Other specified disorders of biliary tract (adhesion, atrophy, cyst, hypertrophy, stasis, or ulcer) (576.8)

  • Calculus of bile duct without mention of cholecystitis without (574.50) and with (574.51) mention of obstruction

  • Complications of transplanted organ: liver (996.82)

Procedures

  • Open biopsy of liver (50.12)

  • Liver transplant: auxiliary (50.51) or other (50.59).

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Worth, P.J., Kaur, T., Diggs, B.S. et al. Major bile duct injury requiring operative reconstruction after laparoscopic cholecystectomy: a follow-on study. Surg Endosc 30, 1839–1846 (2016). https://doi.org/10.1007/s00464-015-4469-2

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