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Long-Term Follow-Up (4-9 Years) of 125 Patients Demonstrates Common Bile Duct Injury Is Associated With Significant Mortality
Caitlin a. Halbert*, Maria Altieri, Jie Yang, Ziqi Meng, Mark a. Talamini, Aurora D. Pryor, Purvi Parikh, Dana a. Telem
Stony Brook University, Stony Brook, NY
INTRODUCTION
Common bile duct (CBD ) injury is a serious and dreaded complication of cholecystectomy. A paucity of data assessing long-term outcomes exists. This study aimed to determine long term mortality and liver transplantation rates following CBD injury requiring operative intervention.
METHODS
Patients were identified via the NYS Planning and Research Cooperative System (SPARCS) longitudinal administrative database which captures patient level data from every inpatient and outpatient hospital discharge in NYS. In total, 125 patients with CBD injuries were identified following 156,958 laparoscopic cholecystectomies for cholelithiasis performed in NYS from 2005-2010. Patients were then tracked by unique identifier to obtain rate of liver transplantation. The Social Security Death Index was used to identify all-cause mortality. Follow-up ranged from 4-9 years from surgery. Statistical analysis was performed by two sample t-test or Kruskal-Wallis Test for continuous variables. Fisher's exact test or Chi-square test was used for categorical variables. Log-rank test compared overall survival among different types of surgeries. Statistical significance was set at 0.05.
RESULTS
Of the 125 patients, 71% were female, 58% White, 72.8% were inpatient at time of cholecystectomy, and 64% were below the age of 61 with mean age of 46 years. Mean time to reparative surgery following CBD injury was 46.44 (range 0 to 363 days). Thirty-one (24.8%) patients underwent hepatectomy, 40 (32.0%) underwent hepaticoenterostomy, 54 (43.2%) underwent primary repair of the bile duct, and 11 (14.2%) required a combination of aforementioned complex procedures. No mortalities occurred within 30-days. All-cause mortality was 20.8% (n=26) with mean time to death 1.64 +/- 1.08 years. One patient who underwent hepaticoenterostomy required a liver transplant 4.3 years after surgery. Significant factors predictive of all-cause mortality included: age>61, Medicare insurance, male gender, White race, diabetes, hypertension, and pulmonary complications following surgery. Overall 30-day morbidity, timing to and type of operative intervention did not influence mortality.
CONCLUSION
Considerable long-term mortality, 20.8%, is associated with common bile duct injury requiring operative intervention. The mortality rate is appreciably higher than quoted previously. No difference was demonstrated by type of repair required. Liver transplant rate was 0.8%. Although CBD injuries are infrequent, long-term prognosis includes a significant risk for early mortality particularly for older patients, those with diabetes and hypertension and those who develop pulmonary complications following surgery. This data has significant implications for patient and family counseling both prior to cholecystectomy and following CBD injury.
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