National Readmissions Database characterization of post-cholecystectomy care for inpatients: Readmissions and bile duct repair

•According to the US National Readmissions Database:•Inpatient Laparoscopic Cholecystectomy accounted for 84.5% of cholecystectomy procedures with a 7% readmission rate, 0.0027% had an injury code, 0.46% required biliary to enteric anastomosis or biliary repair, and 2.98% required radiographic inter...

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Published in:	The American journal of surgery Vol. 222; no. 6; pp. 1186 - 1188
Main Authors:	Hill, Sarah E.M., Jensen, Hanna K., Reif, Rebecca, Karim, Saleema A., Sexton, Kevin W., Kalkwarf, Kyle J., Giorgakis, Emmanouil, Burdine, Lyle
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01.12.2021 Elsevier Limited
Subjects:	Anastomosis Bile ducts Bile Ducts - surgery Cholecystectomy Cholecystectomy - adverse effects Cholecystectomy, Laparoscopic - adverse effects Codes Databases as Topic - statistics & numerical data Emergency medical care Emergency medical services Estimates Female Health care Health care facilities Health services Humans Injuries Laparoscopy Length of stay Litigation Male Medicaid Medicare Middle Aged Patient Readmission - statistics & numerical data Patients Postoperative Care - statistics & numerical data Reoperation - statistics & numerical data Surgery Teaching hospitals United States United States United States > US
ISSN:	0002-9610, 1879-1883, 1879-1883
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Abstract	•According to the US National Readmissions Database:•Inpatient Laparoscopic Cholecystectomy accounted for 84.5% of cholecystectomy procedures with a 7% readmission rate, 0.0027% had an injury code, 0.46% required biliary to enteric anastomosis or biliary repair, and 2.98% required radiographic intervention (ERCP, PTC, IR Drain).•InpatientOpen Cholecystectomy accounted for 15.5% of all cholecystectomy procedures with a 14% readmission rate, 0.25% had an injury code, 6.27% required biliary to enteric anastomosis or biliary repair, and 5.8% required radiographic intervention (ERCP, PTC, IR Drain).
AbstractList	•According to the US National Readmissions Database:•Inpatient Laparoscopic Cholecystectomy accounted for 84.5% of cholecystectomy procedures with a 7% readmission rate, 0.0027% had an injury code, 0.46% required biliary to enteric anastomosis or biliary repair, and 2.98% required radiographic intervention (ERCP, PTC, IR Drain).•InpatientOpen Cholecystectomy accounted for 15.5% of all cholecystectomy procedures with a 14% readmission rate, 0.25% had an injury code, 6.27% required biliary to enteric anastomosis or biliary repair, and 5.8% required radiographic intervention (ERCP, PTC, IR Drain). Most notably, bile duct injury incidence has been reported to be 0.3%–0.6%.4,5 Furthermore, existing data sets estimates that only 25–32% of injuries are actually identified intraoperatively.6–8 In our experience, most bile duct disruptions are not captured at the index operation and are often sent to a tertiary referral center for repair, making accurate estimates of the true bile duct injury and readmission for repair difficult to capture.8–10 Likewise, following surgery, many patients present to emergency rooms at healthcare facilities other than where the initial surgery was performed, resulting in underestimation of true readmission and complication rates. A 2005–2014 retrospective study in California found that operatively managed biliary-enteric anastomosis bile duct repair cost on average an additional $37,867.16 In the UK, the vast majority of claims filed with the National Health Service Litigation Authority were for bile duct injuries from 2000-2005.17 Those claims paid out a total of £4.3 million, a 2020 USD equivalent of $8,383,112.9217.17 We turned to the National Readmissions Database, which is a component of the Healthcare Cost and Utilization Project (HCUP) family of databases, to identify a 2010–2014 holistic patient cohort who underwent cholecystectomy and were readmitted within 90 days to capture the codes, cost, and readmissions following both open and laparoscopic cholecystectomy for patients admitted to the hospital. The goal of this work was to analyze Current Procedural Terminology (CPT) coding in the NRD to gather overall readmission rates, cost, and additional procedures required after a cholecystectomy was performed on admitted patients. While the data from the NRD agrees with this explicit rate of injury measured by the number of injury codes associated with cholecystectomies, the data also suggests that this may be an incomplete understanding of the risk associated with cholecystectomy, as 1.47% of patients required a
Author	Kalkwarf, Kyle J. Burdine, Lyle Hill, Sarah E.M. Reif, Rebecca Jensen, Hanna K. Karim, Saleema A. Sexton, Kevin W. Giorgakis, Emmanouil
Author_xml	– sequence: 1 givenname: Sarah E.M. orcidid: 0000-0003-3646-8273 surname: Hill fullname: Hill, Sarah E.M. organization: College of Medicine University of Arkansas for Medical Sciences, United States – sequence: 2 givenname: Hanna K. orcidid: 0000-0001-8487-7982 surname: Jensen fullname: Jensen, Hanna K. organization: Department of Surgery, University of Arkansas for Medical Sciences, United States – sequence: 3 givenname: Rebecca surname: Reif fullname: Reif, Rebecca – sequence: 4 givenname: Saleema A. surname: Karim fullname: Karim, Saleema A. – sequence: 5 givenname: Kevin W. surname: Sexton fullname: Sexton, Kevin W. organization: Department of Surgery, University of Arkansas for Medical Sciences, United States – sequence: 6 givenname: Kyle J. orcidid: 0000-0003-1693-4935 surname: Kalkwarf fullname: Kalkwarf, Kyle J. – sequence: 7 givenname: Emmanouil orcidid: 0000-0002-5019-5497 surname: Giorgakis fullname: Giorgakis, Emmanouil – sequence: 8 givenname: Lyle surname: Burdine fullname: Burdine, Lyle email: lburdine@uams.edu
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Snippet	•According to the US National Readmissions Database:•Inpatient Laparoscopic Cholecystectomy accounted for 84.5% of cholecystectomy procedures with a 7%... Most notably, bile duct injury incidence has been reported to be 0.3%–0.6%.4,5 Furthermore, existing data sets estimates that only 25–32% of injuries are...
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SubjectTerms	Anastomosis Bile ducts Bile Ducts - surgery Cholecystectomy Cholecystectomy - adverse effects Cholecystectomy, Laparoscopic - adverse effects Codes Databases as Topic - statistics & numerical data Emergency medical care Emergency medical services Estimates Female Health care Health care facilities Health services Humans Injuries Laparoscopy Length of stay Litigation Male Medicaid Medicare Middle Aged Patient Readmission - statistics & numerical data Patients Postoperative Care - statistics & numerical data Reoperation - statistics & numerical data Surgery Teaching hospitals United States
Title	National Readmissions Database characterization of post-cholecystectomy care for inpatients: Readmissions and bile duct repair
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