Surgeon knowledge, behavior, and opinions regarding intraoperative cholangiography
Nader N Massarweh1, Allison Devlin, Jo Ann Broeckel Elrod
1Department of Surgery, University of Washington, Seattle, WA 98195-6410, USA.
Journal of the American College of Surgeons
|February 3, 2009
Summary
Intraoperative cholangiogram (IOC) use significantly reduces common bile duct injury risk during laparoscopic cholecystectomy. However, less experienced surgeons are less likely to use IOC routinely, highlighting a need for targeted quality improvement interventions.
Area of Science:
- Surgical Safety
- Quality Improvement in Surgery
- Minimally Invasive Procedures
Background:
- Laparoscopic cholecystectomy (LC) carries a risk of common bile duct injury.
- Intraoperative cholangiogram (IOC) use reduces this risk by 50%-70%, especially for less experienced surgeons.
- Understanding barriers to routine IOC use is crucial for improving surgical outcomes.
Purpose of the Study:
- To assess the current utilization of intraoperative cholangiogram (IOC) among general surgeons performing laparoscopic cholecystectomy (LC).
- To identify surgeon characteristics and attitudes associated with routine IOC use.
- To inform the development of targeted quality improvement interventions.
Main Methods:
- A survey was mailed to 4,100 general surgeons selected from the American College of Surgeons.
- 1,417 valid responses were analyzed to determine IOC usage patterns and surgeon demographics.
- Data were analyzed to compare routine IOC users with selective IOC users.
Main Results:
- Only 27% of surveyed surgeons reported routine IOC use.
- Academic surgeons and lower-volume surgeons were less likely to use IOC routinely.
- Routine IOC users held more favorable opinions regarding IOC's cost-effectiveness and injury-prevention capabilities.
Conclusions:
- Surgeons with higher risk profiles (inexperienced, low-volume) are less likely to use IOC routinely.
- These high-risk groups, along with those training others, are key targets for interventions promoting wider IOC adoption.
- Increased routine IOC use can further enhance patient safety during LC.
