M. L. Warren1, T. Wyatt1, R. Dev1, B. K. Patel1, J. Luo2, Y. Zhang2,3, K. Y. Pei1 1Texas Tech University Health Sciences Center,Surgery,Lubbock, TX, USA 2Yale School of Public Health,Environmental Health Sciences,New Haven, CT, USA 3Yale School of Medicine,Section Of Surgical Outcomes And Epidemiology,New Haven, CT, USA
Introduction:
There is renewed interest in performing primary laparoscopic common bile duct exploration for choledocholithiasis, but endoscopic retrograde cholangiopancreatography has largely replaced common bile duct exploration while surgical volume and experience are likely low. Despite increasing experience and familiarity with advanced laparoscopic skills, it is unknown whether US surgeons are increasingly adopting laparoscopic common bile duct exploration for common bile duct stones.
Methods:
The ACS NSQIP database was queried for patients undergoing laparoscopic (CPT code 47564) or open common bile duct exploration (CPT code 47610) for diagnosis of choledocholithiasis (identified by ICD 9 and ICD 10 codes) from 2005 to 2016. Trends information was evaluated as percentages of total procedures performed from NSQIP participating hospitals. Standard descriptive statistics was analyzed and multivariable logistic regression were utilized to compare outcomes of interest including complications, mortality, reoperation, and length of stay.
Results:
A total of 1073 procedures were included for analysis. Among NSQIP participating hospitals, the majority of explorations were performed laparoscopically but the percentage of laparoscopic common bile duct exploration remains largely unchanged (Figure 1). After adjusting for patient characteristics, laparoscopic common bile duct exploration was associated with decreased overall complications [OR 0.25 95% CI (0.15-0.40)] and length of stay [OR 0.10 95% CI (0.06-0.16)]. There were no differences in 30-day mortality [OR 0.87 95% CI (0.15-5.00)]or reoperation [OR 0.19 95% CI (0.02-2.23).
Conclusion:
Most NSQIP participating hospitals perform laparoscopic common bile duct exploration but overall experience with common bile duct explorations were low in general. Laparoscopic exploration was associated with decreased overall complication and length stay.
