Abstract
BackgroundBile duct injury (BDI) is a severe complication following cholecystectomy. Early recognition and treatment of BDI has been shown to reduce costs and improve patients’ quality of life. The aim of this study was to assess the effect and cost-effectiveness of routine versus selective intraoperative cholangiography (IOC) in cholecystectomy.MethodsA systematic review and meta-analysis, combined with a health economic model analysis in the Swedish setting, was performed. Costs per quality-adjusted life-year (QALY) for routine versus selective IOC during cholecystectomy for different scenarios were calculated.ResultsIn this meta-analysis, eight studies with more than 2 million patients subjected to cholecystectomy and 9000 BDIs were included. The rate of BDI was estimated to 0.36 per cent when IOC was performed routinely, compared with to 0.53 per cent when used selectively, indicating an increased risk for BDI of 43 per cent when IOC was used selectively (odds ratio 1.43, 95 per cent c.i. 1.22 to 1.67). The model analysis estimated that seven injuries were avoided annually by routine IOC in Sweden, a population of 10 million. Over a 10-year period, 33 QALYs would be gained at an approximate net cost of €808 000 , at a cost per QALY of about €24 900.ConclusionRoutine IOC during cholecystectomy reduces the risk of BDI compared with the selective strategy and is a potentially cost-effective intervention.
Highlights
Cholecystectomy, performed as an emergency or elective procedure, is one of the most common abdominal operations performed by general surgeons’ worldwide[1,2]
Immediate diagnosis of a bile duct injury (BDI) will potentially lead to lower costs for the healthcare system and society resulting in better patient-reported quality of life (QoL)[9,10,11,12]
Principal summary measures for the meta-analysis were the rate of BDI and the odds ratio (OR) for BDI using intraoperative cholangiography (IOC) selectively compared with the routine strategy during cholecystectomy
Summary
Cholecystectomy, performed as an emergency or elective procedure, is one of the most common abdominal operations performed by general surgeons’ worldwide[1,2]. One of the most feared complications, bile duct injury (BDI), is reported to occur in 0.3–1.5 per cent of procedures[1,3,4,5]. Routine intraoperative cholangiography (IOC) has been estimated to prevent 2.5 deaths per 10 000 cholecystectomies, and is reported to increase the number of patients having an intraoperative diagnosis[8,9,10]. Immediate diagnosis of a BDI will potentially lead to lower costs for the healthcare system and society resulting in better patient-reported quality of life (QoL)[9,10,11,12]. Bile duct injury (BDI) is a severe complication following cholecystectomy. The aim of this study was to assess the effect and costeffectiveness of routine versus selective intraoperative cholangiography (IOC) in cholecystectomy
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