Is laparoscopy a risk factor for bile duct injury during cholecystectomy?

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JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons, Vol: 17, Issue: 3, Page: 365-370

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Fullum, Terrence M; Downing, Stephanie R; Ortega, Gezzer; Chang, David C; Oyetunji, Tolulope A; Van Kirk, Kendra; Tran, Daniel D; Woods, Ian; Cornwell, Edward E; Turner, Patricia L
Gall Bladder Surgery; Laparoscopic; Bile Duct Injury; Gall Bladder Surgery; Laparoscopic; Bile Duct Injury; Gastroenterology; Surgery; Surgical Procedures, Operative
article description
BACKGROUND AND OBJECTIVES: 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).CONCLUSION: 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.