title: Ten-year trend in the national volume of bile duct injuries requiring operative repair.
abstract: BACKGROUND
  The objectives of this study were to determine the national proportions and mortality rate for bile duct injuries resulting from laparoscopic cholecystectomy (LC) that required operative reconstruction for repair over a 10-year period and to investigate the major factors associated with the mortality rate in this group of patients.
  
  
  METHODS
  Using the Nationwide Inpatient Sample (NIS) of >7 million patient records per year, we extracted and analyzed data for LC during the years 1990-2000. Procedures that involved biliary reconstructions performed as part of another primary procedure were excluded. Using the Statistical Package for the Social Sciences (SPSS), we used procedure-specific codes that enabled us to calculate national estimates for LC for the time period under review. We then calculated biliary reconstruction procedures that occurred after LC for this cohort of patients. Finally, we analyzed in-hospital mortality, as well as the patient, institutional, and outcome characteristics associated with biliary reconstructions.
  
  
  RESULTS
  The percentage of cholecystectomies performed laparoscopically has increased over the years for which data are available (from 52% in 1991 to 75% in 2000). Despite this increase, the mortality rate for this group of patients has remained consistently low over the study period (mean, 0.45%; range 0.33-0.58%). Within this group of patients, the average rate of bile duct injuries requiring operative repair was 0.15% for the years under study. The reconstruction rates ranged from 0.25% in 1992 to 0.09% in 1999. For 2000, the most recent year for which data are available, biliary reconstruction was performed in 0.10% of all patients who underwent LC. The average mortality rate for patients undergoing biliary reconstruction for the years 1991 to 2000 was 4.5%. After multivariate analysis, age, African American ethnicity, type of admission, source of admission, and hospital location, and teaching status were all found to correlate significantly with death after-biliary reconstruction.
  
  
  CONCLUSIONS
  These data show an increase in the percentage of cholecystectomies performed laparoscopically over the years under study and an associated low mortality rate. In contrast, although the number of bile duct injuries appears to be decreasing, these procedures continue to be associated with a significant mortality rate.
authors.affiliation: Division of General Surgery, Department of Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, L223A, Portland, OR, USA. james.dolan@keesler.af.mil
authors.forename: J P
authors.initials: JP
authors.lastname: Dolan
authors.forename: B S
authors.initials: BS
authors.lastname: Diggs
authors.forename: B C
authors.initials: BC
authors.lastname: Sheppard
authors.forename: J G
authors.initials: JG
authors.lastname: Hunter
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001652:Bile Ducts / Q000293:injuries* / Q000601:surgery; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D002764:Cholecystitis / Q000601:surgery; D002769:Cholelithiasis / Q000601:surgery; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019651:Plastic Surgery Procedures / Q000401:mortality; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology