National survey on cholecystectomy related bile duct injury--public health and financial aspects in Belgian hospitals--1997.
Public health and financial aspects of cholecystectomy related bile duct injury (BDI) are highlighted in a National Cholecystectomy Survey carried out through 'datamining' the Federal State Medical Records Summaries and Financial Summaries of all Belgian hospitals in 1997. All cancer diagnoses, children < or = 10 years, cholecystectomies performed as an abdominal co-procedure or patients having undergone other non-related surgery were excluded from the study. 10.595 laparoscopic (LC) and 1.033 open cholecystectomies (OC) as well as 137 secondary BDI treatments (LC/OC) were included in the survey (total 11.765). Both LC and OC groups turned out to be significantly different as to distribution of patient's age and APR-DRG severity classes. Composite criteria in terms of ICD-9-CM and billing codes were elaborated to classify: 1) primary, intra-operatively detected and treated BDI (N = 30), 2) primary delayed BDI treatments (N = 38), 3) secondary BDI treatments (N = 137), 4) non-BDI abdomino-surgical complications (N = 119), 4) uneventful laparoscopic (N = 7.476) and 5) uneventful open cholecystectomy (N = 681). Complication rates, community costs of LC and OC groups, incidence of preoperative ERCP and/or intra-operative cholangiography as well as interventions for complications were studied. Incidence of cholecystectomy related BDI was 0.37% in LC, 2.81% in OC and 0.58% overall. Average costs amounted to [symbol: see text] 1.721 for uneventful LC, [symbol: see text] 2.924 for uneventful OC, [symbol: see text] 7.250 for primary, intra-operatively detected and immediately treated BDI [symbol: see text] 9.258 for primary delayed BDI treatments, [symbol: see text] 6.076 for secondary BDI treatments and [symbol: see text] 10.363 for non-BDI abdomino-surgical complications. In conclusion BDI with cholecystectomy reveals to be a serious complication increasing the overall average cost factor ninefold if not detected intra-operatively, in which case the raise is only fourfold. As a consequence BDI should be avoided by all means. In this respect 4 crucial surgical guidelines are emphasised.
Van de Sande
St
S
Technical Cell (CT-TC) of the Belgian Federal Ministry of Social Affairs, Public Health and the Environment, National Institute of Sickness & Disability Insurance (RIZIV-INAMI), Brussels, Belgium.
Bossens
M
M
Parmentier
Y
Y
Gigot
J F
JF
D001530:Belgium / Q000453:epidemiology; D017734:Bile Ducts, Extrahepatic / Q000293:injuries*; D002758:Cholangiography / Q000592:standards / Q000706:statistics & numerical data; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000191:economics / Q000592:standards; D039702:Current Procedural Terminology; D019538:Health Care Surveys; D017721:Hospital Costs; D006801:Humans; D007431:Intraoperative Complications / Q000191:economics / Q000453:epidemiology*; D019300:Medical Errors / Q000517:prevention & control / Q000706:statistics & numerical data; D008499:Medical Records; D017410:Practice Guidelines as Topic; D013503:Surgery Department, Hospital / Q000592:standards* / Q000706:statistics & numerical data