Diminished Survival in Patients with Bile Leak and Ductal Injury: Management Strategy and Outcomes

Journal of the American College of Surgeons
Zhi Ven FongCalifornia Cholecystectomy Group

Abstract

The increased incidence of bile duct injuries (BDIs) after the adoption of laparoscopic cholecystectomy has been well documented. However, the longitudinal impact of bile leaks and BDIs on survival and healthcare use have not been studied adequately. The aims of this analysis were to determine the incidence, long-term outcomes, and costs of bile leaks and ductal injuries in a large population. The California Office of Statewide Health Planning and Development database was queried from 2005 to 2014. Bile leaks, BDIs, and their management strategy were defined. Survival was calculated by Kaplan-Meier failure estimates with multivariable regression and propensity analyses. Cost analyses used inflation adjustments and institution-specific cost-to-charge ratios. Of 711,454 cholecystecomies, bile leaks occurred in 3,551 patients (0.50%) and were managed almost exclusively by endoscopists. Bile duct injuries occurred in 1,584 patients (0.22%) with 84% managed surgically. Patients with a bile leak were more likely to die at 1 year (2.4% vs 1.4%; odds ratio 1.85; p < 0.001). Similarly, BDI patients had an increased 1-year mortality (7.2% vs 1.3%; odds ratio 2.04; p < 0.0001). Survival of BDI patients was better with an operative approac...Continue Reading

Citations

Jun 3, 2020·The American Journal of Gastroenterology·Dina S Ahmad, Ashley Faulx
Oct 5, 2018·World Journal of Gastrointestinal Surgery·Aafke H van DijkSandra C Donkervoort
May 15, 2020·Annals of Surgery·L Michael BruntUNKNOWN and the Prevention of Bile Duct Injury Consensus Work Group
Aug 8, 2019·Surgical Endoscopy·Reid FletcherSteven Bonomo
Sep 3, 2020·Surgical Endoscopy·Julie HongAurora D Pryor
May 14, 2020·Surgical Endoscopy·L Michael BruntUNKNOWN Prevention of Bile Duct Injury Consensus Work Group
Nov 26, 2020·Annals of Hepato-biliary-pancreatic Surgery·Supriya SharmaVinay K Kapoor
Mar 19, 2021·Abdominal Radiology·Ronald S ArellanoJonathan Lorenz
Aug 23, 2020·Surgery·Vishal Gupta, Gaurav Jain
Oct 4, 2020·The American Journal of Gastroenterology·Vishal Gupta, Gaurav Jain
Aug 23, 2019·Journal of the American College of Surgeons·Zhi V FongHenry A Pitt
May 14, 2021·The American Journal of Gastroenterology·Vishal Gupta, Gaurav Jain
Jun 12, 2021·World Journal of Emergency Surgery : WJES·Nicola de'AngelisDaniele Sommacale
Nov 22, 2020·HPB : the Official Journal of the International Hepato Pancreato Biliary Association·Brittany CalkinsChet W Hammill

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