Impact of intraoperative cholangiography on postoperative morbidity and readmission: analysis of the NSQIP database

Halawani, Hamzeh M.; Tamim, Hani; Khalifeh, Farah; Mailhac, Aurélie; Jamali, Faek R.

doi:10.1007/s00464-016-4896-8

Cited by 24 publications

(18 citation statements)

References 13 publications

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“…While we are unable to assess the reason for the transfer, generally it is because of acuity or complexity of surgical problem that requires a higher level of care. Previously validated 30 day outcomes including mortality, postoperative complications (Pneumonia, Cardiac Complication, Surgical Site Infection, Urinary Tract Infection, Venous Thromboembolism, Renal Failure, Return to the OR, Sepsis), readmission and discharge to a nursing or rehab facility were also compared 17–20. Standard operation definitions by Current Procedural Terminology code from the ACS-NSQIP were used to describe the case mix.…”

Section: Methodsmentioning

confidence: 99%

Community level socioeconomic status association with surgical outcomes and resource utilisation in a regional cohort: a prospective registry analysis

et al. 2019

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BackgroundSocioeconomic status affects surgical outcomes, however these factors are not included in clinical quality improvement data and risk models. We performed a prospective registry analysis to determine if the Distressed Communities Index (DCI), a composite socioeconomic ranking by zip code, could predict risk-adjusted surgical outcomes and resource utilisation.MethodsAll patients undergoing surgery (n=44,451) in a regional quality improvement database (American College of Surgeons-National Surgical Quality Improvement Program ACS-NSQIP) were paired with DCI, ranging from 0–100 (low to high distress) and accounting for unemployment, education level, poverty rate, median income, business growth and housing vacancies. The top quartile of distress was compared to the remainder of the cohort and a mixed effects modeling evaluated ACS-NSQIP risk-adjusted association between DCI and the primary outcomes of surgical complications and resource utilisation.ResultsA total of 9369 (21.1%) patients came from severely distressed communities (DCI >75), who had higher rates of most medical comorbidities as well as transfer status (8.4% vs 4.8%, p<0.0001) resulting in higher ACS-NSQIP predicted risk of any complication (8.0% vs 7.1%, p<0.0001). Patients from severely distressed communities had increased 30-day mortality (1.8% vs 1.4%, p=0.01), postoperative complications (9.8% vs 8.5%, p<0.0001), hospital readmission (7.7 vs 6.8, p<0.0001) and resource utilisation. DCI was independently associated with postoperative complications (OR 1.07, 95% CI 1.04 to 1.10, p<0.0001) as well as resource utilisation after adjusting for ACS-NSQIP predicted riskConclusionIncreasing Distressed Communities Index is associated with increased postoperative complications and resource utilisation even after ACS-NSQIP risk adjustment. These findings demonstrate a disparity in surgical outcomes based on community level socioeconomic factors, highlighting the continued need for public health innovation and policy initiatives.

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Section: Methodsmentioning

confidence: 99%

Community level socioeconomic status association with surgical outcomes and resource utilisation in a regional cohort: a prospective registry analysis

et al. 2019

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“…Intraoperative cholangiography is sometimes used for enhanced bile duct identification. Two disadvantages of this technique are the exposition of radiation to the patients and health care personnel and the chance of causing bile duct injuries by bile duct cannulation . Other techniques such as ureteral stenting is sometimes performed to visualize the ureter.…”

Section: Visualization Of Vital Structuresmentioning

confidence: 99%

A practical guide for the use of indocyanine green and methylene blue in fluorescence‐guided abdominal surgery

Manen

Handgraaf

Diana

et al. 2018

Journal of Surgical Oncology

252

178

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Near‐infrared (NIR) fluorescence imaging is gaining clinical acceptance over the last years and has been used for detection of lymph nodes, several tumor types, vital structures and tissue perfusion. This review focuses on NIR fluorescence imaging with indocyanine green and methylene blue for different clinical applications in abdominal surgery with an emphasis on oncology, based on a systematic literature search. Furthermore, practical information on doses, injection times, and intraoperative use are provided.

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“…Will an intra-operative cholangiography prevent biliary injury during LC? This point is discussed, enough, already[57-62]. …”

Section: Discussionmentioning

confidence: 88%

Protocol for laparoscopic cholecystectomy: Is it rocket science?

Hori¹,

Oike²,

Furuyama³

et al. 2016

WJG

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Laparoscopic cholecystectomy (LC) does not require advanced techniques, and its performance has therefore rapidly spread worldwide. However, the rate of biliary injuries has not decreased. The concept of the critical view of safety (CVS) was first documented two decades ago. Unexpected injuries are principally due to misidentification of human factors. The surgeon’s assumption is a major cause of misidentification, and a high level of experience alone is not sufficient for successful LC. We herein describe tips and pitfalls of LC in detail and discuss various technical considerations. Finally, based on a review of important papers and our own experience, we summarize the following mandatory protocol for safe LC: (1) consideration that a high level of experience alone is not enough; (2) recognition of the plateau involving the common hepatic duct and hepatic hilum; (3) blunt dissection until CVS exposure; (4) Calot’s triangle clearance in the overhead view; (5) Calot’s triangle clearance in the view from underneath; (6) dissection of the posterior right side of Calot’s triangle; (7) removal of the gallbladder body; and (8) positive CVS exposure. We believe that adherence to this protocol will ensure successful and beneficial LC worldwide, even in patients with inflammatory changes and rare anatomies.

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Impact of intraoperative cholangiography on postoperative morbidity and readmission: analysis of the NSQIP database

Abstract: The use of IOC at the time of LC appears to be associated with a statistically significant decrease in re-admission rates, especially readmissions related to biliary complications.

Cited by 24 publications

References 13 publications

Community level socioeconomic status association with surgical outcomes and resource utilisation in a regional cohort: a prospective registry analysis

Community level socioeconomic status association with surgical outcomes and resource utilisation in a regional cohort: a prospective registry analysis

A practical guide for the use of indocyanine green and methylene blue in fluorescence‐guided abdominal surgery

Protocol for laparoscopic cholecystectomy: Is it rocket science?

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