title: Long-term outcomes of patients with common bile duct injury following laparoscopic cholecystectomy.
abstract: Common bile duct (CBD) injury is a serious and dreaded complication of cholecystectomy. A paucity of data assessing long-term outcomes exists. This study aimed to determine long-term mortality and liver transplantation rates following CBD injury requiring operative intervention.
  
  
  
  Patients were identified via the New York State (NYS) Planning and Research Cooperative System longitudinal administrative database which captures patient-level data from every inpatient and outpatient hospital discharge in NYS. In total, 125 patients with CBD injuries were identified following 156,958 laparoscopic cholecystectomies for cholelithiasis performed in NYS from 2005 to 2010. Patients were then tracked by unique identifier to obtain rate of liver transplantation. Follow-up ranged from 4 to 9 years from surgery.
  
  
  
  There were 125 patients with CBD injuries detected. No mortalities occurred within 30 days. All-cause mortality was 20.8 % (n = 26) with mean time to death 1.64 ± 1.08 years. One patient who underwent hepaticoenterostomy required a liver transplant 4.3 years after surgery. Significant factors predictive of all-cause mortality included: age >61, Medicare insurance, male gender, White race, diabetes, hypertension and pulmonary complications following surgery. Overall 30-day morbidity, timing to and type of operative intervention did not influence mortality.
  
  
  
  Considerable long-term mortality, 20.8 %, is associated with common bile duct injury requiring operative intervention. This was an increase of 8.8 % above the cohort's expected age-adjusted rate of death. The mortality rate is appreciably higher than quoted previously. No difference was demonstrated by type of repair required. Liver transplant rate was 0.8 %. These data have significant implications for patient and family counseling both prior to cholecystectomy and following CBD injury.
authors.affiliation: Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA. caitlinannhalbert@gmail.com.|, 537 Stanton-Christiana Road, Suite 102, Newark, DE, 19713, USA. caitlinannhalbert@gmail.com.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Halbert
authors.affiliation: Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA.
authors.forename: Maria S
authors.initials: MS
authors.lastname: Altieri
authors.affiliation: Department of Preventive Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA.
authors.forename: Jie
authors.initials: J
authors.lastname: Yang
authors.affiliation: Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, USA.
authors.forename: Ziqi
authors.initials: Z
authors.lastname: Meng
authors.affiliation: Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, USA.
authors.forename: Hao
authors.initials: H
authors.lastname: Chen
authors.affiliation: Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Talamini
authors.affiliation: Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA.
authors.forename: Aurora
authors.initials: A
authors.lastname: Pryor
authors.affiliation: Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA.
authors.forename: Purvi
authors.initials: P
authors.lastname: Parikh
authors.affiliation: Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA.
authors.forename: Dana A
authors.initials: DA
authors.lastname: Telem
mesh_terms: D000328:Adult; D000367:Age Factors; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D003135:Common Bile Duct / Q000293:injuries* / Q000601:surgery*; D003920:Diabetes Mellitus / Q000453:epidemiology; D013505:Digestive System Surgical Procedures / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D016031:Liver Transplantation / Q000706:statistics & numerical data; D008297:Male; D006278:Medicare; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D012737:Sex Factors; D014481:United States; D044465:White People; D055815:Young Adult
keywords: Common bile duct injury; Laparoscopic cholecystectomy; Mortality; Transplant
references.citation: Ann Surg. 2005 May;241(5):786-92; discussion 793-5
references.pmid: 15849514
references.citation: Am Surg. 2013 Dec;79(12):1253-7
references.pmid: 24351351
references.citation: Surg Endosc. 1997 Dec;11(12):1171-8
references.pmid: 9373288
references.citation: J Clin Epidemiol. 1995 Dec;48(12):1503-10
references.pmid: 8543964
references.citation: Surg Endosc. 1998 Apr;12(4):315-21
references.pmid: 9543520
references.citation: Natl Vital Stat Rep. 2013 May 8;61(4):1-117
references.pmid: 24979972
references.citation: J Am Coll Surg. 1995 Jan;180(1):101-25
references.pmid: 8000648
references.citation: Surg Endosc. 2016 Jun;30(6):2239-43
references.pmid: 26335071
references.citation: Surg Endosc. 2003 Sep;17(9):1356-61
references.pmid: 12811663
references.citation: JAMA. 2003 Oct 22;290(16):2168-73
references.pmid: 14570952
references.citation: Ann Surg. 2013 Sep;258(3):490-9
references.pmid: 24022441