Impact of intraoperative cholangiography on postoperative morbidity and readmission: analysis of the NSQIP database.
The debate regarding the merits of routine use of intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) continues to rage. We aim to analyze the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database to identify patterns of utilization of cholangiography during LC as well as its impact on patient outcomes.



This is a retrospective cohort study of patients undergoing LC with or without IOC in the 2012 and 2013 ACS NSQIP database. Only patients without any preoperative biochemical evidence of the CBD stone were included in the analysis. Comparison between two groups and data analysis focused on the following primary outcomes: 30-day mortality, readmission, return to operating room and NSQIP collected morbidity.



Twenty-one percentage of patients undergoing LC without any biochemical abnormality are undergoing IOC. There were no statistically significant differences in thirty-day outcomes between two patient populations with regard to mortality, morbidity, cardiac, central nervous system, wound, deep vein thrombosis, sepsis, respiratory and urinary tract complications. Patients undergoing LC plus IOC were found to have statistically significant reduction in the rate of readmission related to the first operation (adjusted odds ratio 0.80, 95 % CI 0.70-0.92; P value = 0.002). Readmissions related to biliary complications including retained CBD following cholecystectomy were 1.61 times more likely in patients who underwent LC without cholangiography.



The use of IOC at the time of LC appears to be associated with a statistically significant decrease in re-admission rates, especially readmissions related to biliary complications.
Department of Surgery, American University of Beirut Medical Center, Cairo Street, Riad El Solh, PO Box 11-0236, Beirut, 1107 2020, Lebanon.
Hamzeh M
HM
Halawani
Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon.
Hani
H
Tamim
Department of Immunology and Microbiology, American University of Beirut Medical Center, Beirut, Lebanon.
Farah
F
Khalifeh
Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon.
Aurélie
A
Mailhac
Department of Surgery, American University of Beirut Medical Center, Cairo Street, Riad El Solh, PO Box 11-0236, Beirut, 1107 2020, Lebanon. fj03@aub.edu.lb.
Faek R
FR
Jamali
D000328:Adult; D000368:Aged; D002758:Cholangiography / Q000706:statistics & numerical data*; D017081:Cholecystectomy, Laparoscopic; D016208:Databases, Factual; D005260:Female; D042882:Gallstones / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007430:Intraoperative Care / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States
Bile duct injury; Common bile duct stones; Intraoperative cholangiography; Laparoscopic cholecystectomy