To examine the impact of bile duct injury (BDI) during cholecystectomy on hospital length of stay and costs.

METHODS: The latest available 2016 National Inpatient Sample (NIS) data set from the Healthcare Cost and Utilization Project was utilized in order to determine the number of hospital admissions for patients with cholecystectomy. Bile duct injury was identified using previously validated ICD-10 codes. Propensity score matched analysis was conducted to compare hospital LOS and costs in patients with and without BDI. Thirty comorbidities were assessed using Elixhauser scoring. Multivariate logistic regression was conducted to assess predictor variables for LOS and costs.

RESULTS:

In 2016, there were an estimated 351,505 hospitalizations with a procedure code of cholecystectomy, of which 5300 had a diagnosis code of BDI. The mean age was 35.2 (SD 21.6) and 63.1 (SD 18.1), and 69.2% and 64.0% were female, in patients without and with BDI, respectively. Most common comorbidities were cardiac arrhythmias (13.3%), hypertension (39.2%), chronic pulmonary disease (14.0%), diabetes (13.5%) and obesity (23.6%). The propensity score matched hospital LOS was 5.0 and 10.9 days, with a statistically significant difference of 4.9 days (SE 0.72, P<0.05), and hospital charges were $42,908 and $156,120, with a statistically significant difference of $113,212 (SE $7514, P<0.05), in patients without and with BDI, respectively.

CONCLUSIONS: Patients with BDI during cholecystectomy incur significantly higher hospital charges and longer length of stay compared to patients with no BDI. There is a need for better treatment management for patients who are at risk of BDI during cholecystectomy.