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INDICATIONS AND OUTCOMES OF BILE DUCT RECONSTRUCTION OVER TIME IN THE NSQIP DATABASE
Veer S. Sawhney
*1,2, Sing Chau Ng
1,2, Anays Murillo
1,2, Kelly Kenzik
1,2, Teviah Sachs
1,2, Jennifer F. Tseng
21Surgery, Boston Medical Center, Boston, MA; 2Boston University Chobanian & Avedisian School of Medicine, Boston, MA
Background:Reconstruction of the biliary tree (common bile duct, common hepatic duct, intrahepatic ducts) has several indications, including bile duct injury, neoplasms and stricture with varying outcomes. We compared outcomes of patients who underwent bile duct reconstruction (BDR) based on indication.
Methods:We queried the ACS-NSQIP Participant Use File for BDR patients from 2013 – 2022. Patients were identified and grouped based on indication. We compared groups by year (2013 – 2017 vs. 2018 – 2022), demographics, and comorbidities using chi-square analysis. 30-day outcomes including complications and readmissions were also compared using multivariable logistic regression. Patients with missing variables were excluded.
Results:We identified 1729 patients who underwent BDR. Of these, 33.5% were for biliary obstruction, 27.4% were for pancreatic malignancy (PCa), 11.5% were for biliary malignancy (BCa), 9.0% were bile duct injury (BDI), and 18.6% were for other diagnoses, including choledochal cysts and pancreatitis.
Of all patients, the majority were female (51.5%), ? 65 years old (61.0%), identified as white (71.3%) and non-Hispanic (89.8%). Nearly two-thirds of BDR (61.1%) occurred between 2013 – 2017, suggesting a decrease in BDR over time.
Surgical site infection was most common in BCa (25.1%), and least common with PCa (14.8%) (P = 0.002). Unplanned readmissions within 30 days occurred with similar frequency in all groups (overall 13.0%; P = 0.20). Other complications within 30 days, including mortality, were low, but were twice as common in malignancy as compared to non-malignant BDR (12.0% vs 6.2%; P = 0.001).
Conclusion:Bile Duct Reconstruction appears to be occurring with less frequency in NSQIP hospitals over time, perhaps due to improved endoscopic and interventional techniques. Major complications were more common with non-malignant indications, but readmissions were similar between groups. These results must be interpreted with the understanding that NSQIP hospitals vary over the time course of the study.
Table 1.
Demographics of patients who underwent bile duct reconstruction surgery by indication surgery and outcomes by indication
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