National survey on cholecystectomy related bile duct injury - Public health and financial aspects in Belgian hospitals - 1997
(2003) Acta Chirurgica Belgica (Bilingual Edition) — Vol. 103, n° 2, p. 168-180 (2003)
Files
41039.pdf
Restricted Access - Adobe PDF
- 3.68 MB
Details
- Authors
- Abstract
- Public health and financial aspects of cholecystectomy related bile duct injury (BDI) are highlighted in a National Cholecystectomy Survey carried out through 'datamining' the Federal State Medical Records Summaries and Financial Summaries of all Belgian hospitals in 1997. All cancer diagnoses, children less than or equal to 10 years, cholecystectomies performed as an abdominal co-procedure or patients having undergone other non-related surgery were excluded from the study. 10.595 laparoscopic (LC) and 1.033 open cholecystectomies (OC) as well as 137 secondary BDI treatments (LC/OC) were included in the survey (total 11.765). Both LC and OC groups turned out to be significantly different as to distribution of patient's age and APR-DRG severity classes. Composite criteria in terms of ICD-9-CM and billing codes were elaborated to classify : 1) primary, intra-operatively detected and treated BDI (N = 30), 2) primary delayed BDI treatments (N = 38), 3) secondary BDI treatments (N = 137), 4) non-BDI abdomino-surgical complications (N = 119), 4) uneventful laparoscopic (N = 7.476) and 5) uneventful open cholecystectomy (N = 681). Complication rates, community costs of LC and OC groups, incidence of preoperative ERCP and/or intra-operative cholangiography as well as interventions for complications were studied. Incidence of cholecystectomy related BDI was 0,37% in LC, 2,81% in OC and 0,58% overall. Average costs amounted to E 1.721 for uneventful LC, E 2.924 for uneventful OC, E 7.250 for primary, intra-operatively detected and immediately treated BDI, E 9.258 for primary delayed BDI treatments, E 6.076 for secondary BDI treatments and E 10.363 for non-BDI abdomino-surgical complications. In conclusion BDI with cholecystectomy reveals to be a serious complication increasing the overall average cost factor ninefold if not detected intra-operatively, in which case the raise is only fourfold. As a consequence BDI should be avoided by all means. In this respect 4 crucial surgical guidelines are emphasised.
- Affiliations
Citations
Van de Sande, S., Bossens, M., Parmentier, Y., & Gigot, J.-F. (2003). National survey on cholecystectomy related bile duct injury - Public health and financial aspects in Belgian hospitals - 1997. Acta Chirurgica Belgica (Bilingual Edition), 103(2), 168-180. https://doi.org/10.1080/00015458.2003.11679403 (Original work published 2003)