A comprehensive evaluation of the long-term economic impact of major bile duct injury.

Halle-Smith, James M, Hodson, James, Stevens, Lewis G, Dasari, Bobby, Marudanayagam, Ravi, Perera, Thamara, Sutcliffe, Robert P, Muiesan, Paolo, Isaac, John, Mirza, Darius F and Roberts, Keith J (2019) A comprehensive evaluation of the long-term economic impact of major bile duct injury. HPB : the official journal of the International Hepato Pancreato Biliary Association, 21 (10). pp. 1312-1321. ISSN 1477-2574. This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs

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Official URL: https://www.hpbonline.org/article/S1365-182X(19)30...

Abstract

BACKGROUND

Complications and litigation after bile duct injury (BDI) result in clinical and economic burden. The aim of this study was to comprehensively evaluate the long-term clinical and economic impact of major BDI.

METHOD

Patients with long-term follow-up after Strasberg E BDI were identified. Costs of treatment and litigation were the primary outcome. Relationships between these outcomes and repair factors, like timing of repair and surgeon expertise, were secondary outcomes.

RESULTS

Among 139 patients with a median follow up of 10.7 years, 40% of patients developed biliary complications. Repairs by non-specialist surgeons had significantly higher follow up and treatment costs than those by specialists (£25,814 vs. £14,269, p < 0.001). Estimated litigation costs were higher in delayed than immediate repairs (£23,295 vs. £12,864). As such, the lowest average costs per BDI are after immediate specialist repair and the highest after delayed non-specialist repair (£27,133 vs. £49,109, ×1.81 more costly, p < 0.001). Repair by a non-specialist surgeon (HR: 4.00, p < 0.001) and vascular injury (HR: 2.35, p = 0.013) were significant independent predictors of increased complication rates.

CONCLUSION

Costs of major BDI are considerable. They can be reduced by immediate on-table repair by specialist surgeons. This must therefore be considered the standard of care wherever possible.

Item Type: Article
Additional Information: This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs
Subjects: WI Digestive system. Gastroenterology
WO Surgery
Divisions: Planned IP Care > Gastroentrology
Related URLs:
Depositing User: Gareth Sunley
Date Deposited: 17 Jul 2020 15:04
Last Modified: 17 Jul 2020 15:04
URI: http://www.repository.uhblibrary.co.uk/id/eprint/3284

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