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Management of Bile Duct Injuries in the United States: a Contemporary Analysis
*Lindsay A Bliss1,2, *Osman K Yousafzai1, *Susanna WL de Geus1, Tara S Kent1, *Khalid Khwaja1, David W McFadden2, Mark P Callery1, Jennifer F Tseng1
1Beth Israel Deaconess Medical Center, Boston, MA;2University of Connecticut School of Medicine, Farmington, CT

Objective:
This study describes U.S. trends in bile duct injury (BDI) management and associated outcomes.
Design:
Retrospective descriptive analysis of inpatient admissions for patients with BDIs included in the Nationwide Inpatient Sample 2004-2011. Patient and hospital characteristics, imaging, inpatient complications, and disposition were analyzed by chi-square. Patient outcomes were stratified by bile duct-related intervention and whether transferred to the admitting hospital. To estimate BDI incidence, we separately identified the total number of cholecystectomies performed nationally.
Setting:
Inpatient hospital admissions in the United States
Patients:
All patients ≥18 years old discharged from 2004-2011 with ICD-9 diagnosis codes for BDI
Interventions:
None
Main Outcome Measures:
Inpatient complications, death and length of stay (LOS)
Results:
We identified 7,793 weighted patient discharges with BDI, of which 621 (8.0%) and 3,871 (49.7%) were associated with same-admission laparoscopic and open cholecystectomy, respectively. 1,414 (18.1%) and 503 patients (6.5%) underwent intraoperative cholangiography and endoscopic retrograde cholangiopancreatography. 945 patients (12.1%) underwent endoscopic stent placement. 5,658 patients (72.6%) were discharged to home, while 1,042 (13.4%) were discharged to a facility and 620 patients (8.0%) died. 474 patients (6.1%) were transferred to the admitting hospital. Median LOS and costs per admission were 8 days (IQR 5,16) and \,347 (IQR \,105,\,254). Nationally, 3,482,765 cholecystectomies (79.7% laparoscopic) were performed, for estimated BDI incidence of ~1/450.
Conclusions:
BDI is a serious complication. Management of BDI varies widely in clinical practice, and national data is lacking. Although bile duct injuries are uncommon, they result in long, costly admissions and >600 inpatient deaths annually. Increasing use of laparoscopic cholecystectomy and endobiliary procedures in the current era mandates further examination of best practices to prevent and treat BDIs.


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