Original scientific article
Risk Tolerance and Bile Duct Injury: Surgeon Characteristics, Risk-Taking Preference, and Common Bile Duct Injuries

https://doi.org/10.1016/j.jamcollsurg.2009.02.063Get rights and content

Background

Little is known about surgeon characteristics associated with common bile duct injury (CBDI) during laparoscopic cholecystectomy (LC). Risk-taking preferences can influence physician behavior and practice. We evaluated self-reported differences in characteristics and risk-taking preference among surgeons with and without a reported history of CBDI.

Study Design

A mailed survey was sent to 4,100 general surgeons randomly selected from the mailing list of the American College of Surgeons. Surveys with a valid exclusion (retired, no LC experience) were considered responsive, but were excluded from data analysis.

Results

Forty-four percent responded (1,412 surveys analyzed), 37.7% reported being the primary surgeon when a CBDI occurred, and 12.9% had more than one injury. Surgeons reporting an injury were slightly older (52.8 ± 9.0 years versus 51.3 ± 9.8 years; p < 0.004) and in practice longer (20.8 ± 9.7 years versus 18.9 ± 10.5 years; p < 0.001). Surgeons not reporting a CBDI were more likely trained in LC during residency (63.3% versus 55.4% injuring) as compared with surgeons reporting a CBDI, who were more likely trained at an LC course (29.8% versus 38.2%). Surgeons in academic practice or who work with residents had lower reported rates of CBDI (7.9% versus 14.5% [academics]; 18.7% versus 25.0% [residents]). Mean risk score was 12.4 ± 4.4 (range 6 to 30 [30 = highest]) with a similar average between those who did (12.2 ± 4.5) and did not (11.9 ± 4.4) report a CBDI (p < 0.23). Compared with surgeons in the lowest three deciles of risk score, relative risk for CBDI among surgeons in the upper three deciles was 17% greater (p = 0.07).

Conclusions

More years performing LC and certain practice characteristics were associated with an increased rate of CBDI. The impact of extremes of risk-taking preference on surgical decision making can be an important part of decreasing adverse events during LC and should be evaluated.

Section snippets

Methods

All procedures used to conduct this study were approved by the University of Washington Institutional Review Board. A random sample of 5,000 American College of Surgeons members was selected from the roster of “general surgeons” to receive this mailed survey. The survey content and the mailing methodology have been described in an earlier study.13

Although the JPI risk-taking subscale in its entirety is composed of 20 questions, pilot data from the Pearson study using this risk-taking subscale

Results

A total of 4,100 surveys were mailed. One hundred eight were not post-deliverable and were discounted when calculating response rate. Among surgeons who returned an incomplete survey (n = 303), the most commonly noted reason was retirement (63%), followed by cholecystectomy not being a part of the practice (16.6%), no reason offered (13%), and deceased (7.3%). Total response rate to the survey was 1,756 of 3,992 (44%) and included incomplete surveys returned with a valid reason. After

Discussion

CBDI during LC is a relatively uncommon complication.1, 2 The impact on a patient's quality of life and the subsequent economic and clinical consequences of such injuries are profound.8, 9, 10, 11 Our group recently published results from a survey of US surgeons examining reported differences in practice between routine and selective cholangiographers and found considerable differences with regard to knowledge, use, and opinions about IOC.13 Here we report results of a unique aspect of the

Author Contributions

Study conception and design: Broeckel Elrod, Flum

Acquisition of data: Devlin, Broeckel Elrod, Flum

Analysis and interpretation of data: Massarweh, Devlin, Gaston Symons

Drafting of manuscript: Massarweh, Devlin

Critical revision: Massarweh, Flum

Acknowledgment

We thank the American College of Surgeons for their gracious support of this research.

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