Although common bile duct (CBD) injury during cholecystectomy is a significant source of patient morbidity its impact on survival is unclear.
|The adjusted hazard ratio for death during follow-up was 2.79.|
|Journal of the American Medical Association|
In this study, doctors from the United States assessed the relationship between CBD injury and survival. They also identified factors associated with improved survival among Medicare beneficiaries.
The team performed a retrospective study using Medicare National Claims History Part B data, from 1992 to 1999. These data were linked to death records and to the American Medical Association's Physician Masterfile.
They reviewed all records with a procedure code for cholecystectomy. Records with an additional procedure code for repair of the CBD within 365 days of cholecystectomy were defined as having a CBD injury.
The doctors measured survival after cholecystectomy, while controlling for patient and surgeon characteristics.
Of the 1,570,361 patients identified by the team, 7911 patients (0.5%) had CBD injuries.
The team found that 33% of all patients died within the 9.2-year follow-up period.
Overall, 55% of patients without CBD injury remained alive, compared with 20% of those with CBD injury.
The adjusted hazard ratio for death during the follow-up period was significantly higher (2.79) for patients with a CBD injury than those without CBD injury.
This hazard increased with advancing age and comorbidities, and decreased with the experience of the repairing surgeon.
The team determined that the adjusted hazard of death during follow-up was 11% greater if the repairing surgeon was the same as the injuring surgeon.
Dr David Flum's team concluded, "The association between CBD injury during cholecystectomy and survival among Medicare beneficiaries is stronger than suggested by previous reports".
"Referring patients with CBD injuries to surgeons or institutions with greater experience in CBD repair may represent a system-level opportunity to improve outcome".