Abstracts
1998 Digestive Disease Week

#1053

DECLINING RATE OF COMMON BILE DUCT OPERATIONS: A STATE-WIDE, FIVE-YEAR TIME-SERIES ANALYSIS. T Huynh, R. Rutledge, J.S. Guy and C.C. Baker. Department of Surgery, University of North Carolina, Chapel Hill, North Carolina.

Introduction: Endoscopic techniques offer an alternative to surgical therapy in the management of common bile duct (CBD) stones. This study tested the hypothesis that the use of ERCP for CBD stones is associated with equivalent survival, shorter length of stay (LOS) and decreased rate of CBD exploration (CBDE).

Methods: Data were obtained from a 157-hospital statewide discharge database. Patients with diagnoses of biliary tract disease (ICD-9 codes 574-576.9) were selected. Surgical and endoscopic procedures were identified.

Results: From 1988 to 1992, 76,817 patients were admitted for biliary tract diseases (Table). While admissions for CBD stones remained constant at 10%-11%, the number of CBDE declined from 1,541 in 1988 to 1,143 in 1991. Linear regression analysis predicted a continued decline in CBDE to only 12% of admissions for CBD stones in 1996. Survival remained unchanged. The average LOS for patients with CBD stones declined from 9.2 days in 1988 to 7.7 days in 1992 (p=0.01). The number of ERCP performed increased throughout the study.

*Data available for part of 71992

Conclusions: This present study documents a major statewide change in the management of CBD stones, and supports the hypothesis that increased use of ERCP for CBD stones is associated with a significant decline in the rates of surgical CBD exploration, while maintaining survival rates and shortening hospital LOS. These trends have implications for surgical practice patterns and resident education.

Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.