title: Is laparoscopy a risk factor for bile duct injury during cholecystectomy?
abstract: OBJECTIVE
  Previously, risk factors for bile duct injury have been identified as acute cholecystitis, male gender, older age, aberrant biliary anatomy, and laparoscopic cholecystectomy.
  
  
  METHODS
  A retrospective analysis of the Nationwide Inpatient Sample from 1998 to 2006 was performed with an inclusion criterion of cholecystectomy performed on hospital day 0 or 1. Patient- and hospital-level factors potentially associated with bile duct injury were examined by logistic regression.
  
  
  RESULTS
  A total of 377,424 cholecystectomy patients were identified. There were 1124 bile duct injuries (0.30%), with 177 (0.06%) in the laparoscopic cholecystectomy group and 947 (1.46%) in the open cholecystectomy group (P < .001). On multivariate analysis, significant risk factors for bile duct injury were male gender (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.06-1.38; P = .006), age >60 years (OR, 2.23; 95% CI, 1.61-3.09; P < .001), and academic hospital status (OR, 1.37; 95% CI, 1.05-1.79; P = .02). Acute cholecystitis was associated with a lower risk of bile duct injury (OR, 0.67; 95% CI, 0.46-0.99; P = .044).
  
  
  CONCLUSIONS
  Independent risk factors for bile duct injury included male gender, age >60 years, and academic hospital status. Laparoscopic cholecystectomy, obesity, insurance status, or hospital volume was not associated with an increased risk of bile duct injury.
authors.affiliation: Division of Minimally Invasive and Bariatric Surgery, Howard University College of Medicine, 2041 Georgia Ave NW, Ste 4100B, Washington, DC 20059, USA. tfullum@howard.edu.
authors.forename: Terrence M
authors.initials: TM
authors.lastname: Fullum
authors.forename: Stephanie R
authors.initials: SR
authors.lastname: Downing
authors.forename: Gezzer
authors.initials: G
authors.lastname: Ortega
authors.forename: David C
authors.initials: DC
authors.lastname: Chang
authors.forename: Tolulope A
authors.initials: TA
authors.lastname: Oyetunji
authors.forename: Kendra
authors.initials: K
authors.lastname: Van Kirk
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Tran
authors.forename: Ian
authors.initials: I
authors.lastname: Woods
authors.forename: Edward E
authors.initials: EE
authors.lastname: Cornwell
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Turner
mesh_terms: D000367:Age Factors; D000368:Aged; D001652:Bile Ducts / Q000293:injuries*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D007431:Intraoperative Complications / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
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