Performance of the American College of Surgeons National Surgical Quality Improvement calculator for early postoperative outcomes following bile duct repair hepaticojejunostomy.

Abstract

A Roux-en-Y hepaticojejunostomy (HJ) is the preferred method for repairing bile duct injuries (BDIs). The American College of Surgeons (ACS) established the National Surgical Quality Improvement Program (NSQIP) online risk calculator to predict risks for morbidity and mortality. The objective of the study is to assess the use of the ACS NSQIP calculator for patients undergoing HJ for BDI repairs outside the NSQIP cohort. An IRB-approved retrospective study of Bismuth-Strasberg type E BDI HJ (2008-2020) was performed. Clinical data was introduced in the NSQIP calculator, and morbidity and mortality were determined. Perioperative risk factors were obtained. Comparisons of postoperative complications and NSQIP-predicted complication rate were carried out. Eighty-two patients were included (age: 42.2 ± 15.7 years; 81% female; BMI 27.1 ± 4.4 kg/m2). The most common injury was E4 (36.3%). A total of 40.2% patients had a 30-day complication. Mortality was 2.4%. Preoperative sepsis and high body mass index (p = 0.01) were significantly related to complications (p = 0.01) (univariate analysis). Older age (p = 0.01) and higher ASA class (p = 0.02) were significantly related to mortality (univariate analysis). None was statistically significant in multivariate analysis. Comparison between morbidity and mortality and the calculated NSQIP was not statistically significant. Postoperative mortality had a statistically significant trend (C-value = 0.72, p = 0.055). Preoperative sepsis, high body mass index, age, and ASA classification were associated with worse outcomes in HJ BDI repair. The ACS NSQIP calculator did not have a good performance in a population outside the NSQIP data. Further larger studies will need to corroborate these results.