A comprehensive evaluation of the long-term clinical and economic impact of minor bile duct injury

• Published in: Surgery Vol. 167; no. 6; pp. 942 - 949
• Main Authors: Halle-Smith, James M., Hodson, James, Stevens, Lewis G., Dasari, Bobby, Marudanayagam, Ravi, Perera, Thamara, Sutcliffe, Robert P., Muiesan, Paolo, Isaac, John, Mirza, Darius F., Roberts, Keith J.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2020
• Subjects: Anastomosis, Roux-en-Y - economics; Bile Ducts - injuries; Bile Ducts - surgery; Cholecystectomy, Laparoscopic - adverse effects; Costs and Cost Analysis; Female; Follow-Up Studies; Humans; Iatrogenic Disease - economics; Intraoperative Complications - etiology; Intraoperative Complications - surgery; Male; Middle Aged; Patient Care Team; Retrospective Studies; United Kingdom; Wounds and Injuries - classification; United Kingdom
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2020.01.022

Outcomes after Strasberg grade E bile duct injury have been widely reported. However, there are comparatively few reports of outcomes after Strasberg A to D bile duct injury. Therefore, the aim of this study was to comprehensively evaluate the long-term clinical and economic impact of Strasberg A to D bile duct injury. Patients with Strasberg A to D bile duct injury were identified from a prospectively collected and maintained database. Long-term biliary complication rates, as well as treatment costs were then estimated, and compared across Strasberg injury grades. A total of N = 120 patients were identified, of whom N = 49, 13, 20, and 38 had Strasberg grade A, B, C, and D bile duct injury, respectively. Surgical repair was most commonly performed in Strasberg grade D injuries (74% vs 8%–20% in lower grades, P < .001). By 5 years post bile duct injury, the estimated long-term biliary complication rate was 40% in Strasberg grade D injuries, compared with 15% in Strasberg grade A (P = .022). A significant difference in total treatment and follow-up costs was also detected (P < .001), being highest in Strasberg grade D injuries (mean £11,048/US$14,252 per patient) followed by the Strasberg grade B group (mean £10,612/US$13,689 per patient). Strasberg grade A to D injuries lead to considerable long-term morbidity and cost. Strasberg grade D injuries are typically managed surgically and result in the highest complication rate and treatment costs. Strasberg grade B injuries lead to a similar complication rate and treatment cost but are often managed without surgery.