Bile duct injuries during pediatric laparoscopic cholecystectomy: a national perspective
Mehul V Raval1, Timothy B Lautz, Marybeth Browne
1Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois, USA. m-raval@md.northwestern.edu
Insights
Bile duct injuries (BDI) are rare but costly complications of laparoscopic cholecystectomy (LC) in children. Younger age, nonwhite race, and elective admissions are associated with increased BDI risk.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Surgical Complications
Background:
- Bile duct injuries (BDI) are rare but serious complications during laparoscopic cholecystectomy (LC).
- Understanding the incidence and risk factors for BDI in pediatric patients is crucial for improving surgical outcomes.
Purpose of the Study:
- To assess the national trends in LC use and BDI incidence in pediatric patients.
- To quantify the resource utilization associated with BDI in children.
- To identify patient and hospital factors linked to BDI in pediatric LC.
Main Methods:
- Utilized the Kids' Inpatients Database (1997-2006) to identify pediatric patients (0-20 years) undergoing cholecystectomy.
- Calculated national LC use rates and BDI incidence using weighted estimates.
- Employed logistic regression to analyze factors associated with BDI.
Main Results:
- LC use increased from 81% to 91% in pediatric cholecystectomies between 1997 and 2006.
- The incidence of BDI during LC was 0.44%, with no significant change over time.
- BDI patients experienced longer hospital stays (6.1 vs 3.3 days) and higher costs (US $9550 vs $6030).
- BDI was more frequent in younger children (≤5 years), nonwhite patients, and those admitted electively.
Conclusions:
- Despite rising LC use, BDI remains a significant, resource-intensive complication in pediatric surgery.
- Factors such as age, race, and admission type are associated with BDI risk in children.
- Identifying these factors can guide strategies to mitigate BDI and enhance patient outcomes.
Background:
Though rare, bile duct injuries (BDI) during laparoscopic cholecystectomy (LC) represent a major potential complication with significant associated morbidity. The objectives of this study were to (1) assess the national use of LC and incidence of BDI over time in the pediatric surgical population, (2) measure the added resource utilization burden associated with BDI, and (3) identify patient and hospital factors associated with BDI.
Methods:
All patients 0 to 20 years of age undergoing cholecystectomy were identified in the Kids' Inpatients Database from 1997 to 2006. National rates of LC use and BDI as well as overall costs were assessed using weighted estimates. Factors associated with BDI were analyzed with a logistic regression model.
Results:
Of 31,653 patients undergoing cholecystectomy, 28,243 (89.2%) underwent LC. Over time, the proportion of LC has risen from 81% in 1997 to 91% in 2006 (P < .001). Of patients undergoing LC, 0.44% had BDI with no significant change of BDI rate over time. Length of stay was 6.1 days for patients with BDI compared to 3.3 days for those without injury (P < .001). BDI patients had median costs of US $9550 as compared to US $6030 for non-BDI patients (P < .001). After taking patient, hospital, and disease-specific factors into consideration, BDI was more common in patients 5 years of age or less, nonwhite patients, and in patients admitted under an elective setting (all P < .01).
Conclusions:
With increasing LC use, BDI remains a rare yet resource intense complication in children. Age, race, and admission related factors are associated with BDI and may provide guidance toward improving outcomes.
