K. Zhang1, V. Natkha1, J. Mccauley1, M. L. Warren1, J. Luo3, Y. Zhang2,3, K. Y. Pei1 1Texas Tech University Health Sciences Center,Surgery,Lubbock, TX, USA 2Yale School of Medicine,Section Of Surgical Outcomes And Epidemiology,New Haven, CT, USA 3Yale School of Public Health,Environmental Health Sciences,New Haven, CT, USA
Introduction:
Common bile duct injury and retained stones continue to be rare, but potentially catastrophic outcomes of laparoscopic cholecystectomy. Although still controversial and unsettled, there is some evidence that intraoperative cholangiography during laparoscopic cholecystectomy may mitigate such complications. Despite multiple national practice management guidelines espousing liberal use of intraoperative cholangiography, it is unknown practice patterns among US surgeons.
Methods:
The ACS NSQIP database was queried for patients undergoing laparoscopic cholecystectomy with (CPT code 47563) and without (CPT code 47562) intraoperative cholangiography for diagnosis of cholecystitis (identified by ICD 9 and ICD 10 codes) from 2005 to 2016. Patients undergoing cholangiogram for known common bile duct stones were excluded. Trends and practice patterns were evaluated as percentages of total procedures performed from NSQIP participating hospitals. Standard descriptive statistics were analyzed using student t test, chi-squared as indicated. Multivariable logistic regression was utilized to compare outcomes of interest including complications, mortality or reoperation.
Results:
A total of 19,636 procedures (80.3% without cholangiography) were included for analysis. There were no significant differences among patient characteristics between the 2 groups. Among NSQIP participating hospitals, majority of surgeons do not perform intraoperative cholangiogram and there appears to be an increasing trend to forgo cholangiography during the study period (Figure 1). After adjusting for patient characteristics, there were no differences in overall complications [OR 0.86 95% CI (0.74-1.00)], 30-day mortality [OR 0.95 95% CI (0.59-1.52)],or reoperation [OR 1.16 95% CI (0.31-4.35)].
Conclusion:
Most surgeons do not perform intraoperative cholangiography during laparoscopic cholecystectomy for cholecystitis. There were no significant differences in overall complications, mortality, or reoperative risk.
