Comparing early and delayed repair of common bile duct injury to identify clinical drivers of outcome and morbidity.
Outcomes following repair of common bile duct injury (CBDI) are influenced by center and surgeon experience. Determinants of morbidity related to timing of repair are not fully described in this population.



Patients with CBDI managed surgically at a single center from January 2008 to June 2015 were retrospectively reviewed. Outcomes of patients undergoing early (≤48 h from injury) and delayed (>48 h) repair were compared. Predictive modeling for readmission was performed for patients undergoing delayed repair.



In total, 61 patients underwent surgical biliary reconstruction. Between the early and delayed repair groups, no differences were found in patient demographics, injury classification subtype, vasculobiliary injury (VBI) incidence, hospital length of stay, 30-day readmission rate, or 90-day mortality rate. Patients undergoing delayed repair exhibited increased chance of readmission if VBI was present or if multiple endoscopic procedures were performed prior to repair. A predictive model was constructed with these variables (ROC 0.681).



When managed by a tertiary hepatopancreatobiliary center, equivalent outcomes can be realized for patients undergoing early and delayed repair of CBDI. Establishment of evidence-based consensus guidelines for evaluation and treatment of CBDI may allow identification of factors that drive morbidity and predict clinical outcomes in this population.
Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, NC, USA.
Russell C
RC
Kirks
Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, NC, USA.
T E
TE
Barnes
Division of Surgical Oncology, Department of General Surgery, Carolinas Medical Center, Charlotte, NC, USA.
Patrick D
PD
Lorimer
Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, NC, USA.
Allyson
A
Cochran
Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, NC, USA.
Imran
I
Siddiqui
Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, NC, USA.
John B
JB
Martinie
Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, NC, USA.
Erin H
EH
Baker
Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, NC, USA.
David A
DA
Iannitti
Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, NC, USA. Electronic address: Dionisios.Vrochides@carolinashealthcare.org.
Dionisios
D
Vrochides
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D002983:Clinical Competence; D003135:Common Bile Duct / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D010359:Patient Readmission; D012189:Retrospective Studies; D012307:Risk Factors; D066231:Surgeons; D062606:Tertiary Care Centers; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D055815:Young Adult