Ven Fong Z, et al. - This analysis was planned to assess the incidence, long-term outcomes and costs of bile leaks and ductal injuries in a large population. Compared to the reported incidence of bile duct injury in the first decade after the introduction of laparoscopic cholecystectomy, the 0.22% incidence of bile duct injury observed in California was lower. Bile leaks, compared to bile duct injuries (BDI), were 2.3 times more common. Patients suffering a bile leak or BDI showed diminished survival. Enhanced survival and reduced cumulative cost were observed with surgical repair of a BDI compared to endoscopic management.

Methods

• Researchers searched the California Office of Statewide Health Planning and Development database from 2005-14.
• They defined bile leaks, BDIs and their management strategy.
• Kaplan-Meier failure estimates with multivariable regression and propensity analyses were used to calculate survival.
• Inflation adjustments and institution-specific cost-to-charge ratios were used for cost analyses.

Results

• Researchers identified 711,454 cholecystecomies; in 3,551/ 711,454 patients (0.50%), bile leaks occurred and were managed almost exclusively by endoscopists.
• In 1,584 patients (0.22%), BDIs were observed, 84% of these were managed surgically.
• With a bile leak, patients were more likely to die at one year (2.4% vs 1.4%, OR 1.85, p<0.001).
• Similarly, BDI patients showed an increased one-year mortality risk (7.2% vs 1.3%, OR 2.04 p<0.0001).
• With an operative approach, better survival of BDI patients was evident (OR 0.19, p < 0.001) when compared to endoscopic management.
• Fewer Emergency Department visits and readmissions as well as lower cumulative costs at 1-year were noticed in association with operatively managed BDIs ($60,539 vs $118,245, p < 0.001).