Increasing use of intraoperative cholangiogram in Australia: is it evidence‐based?. Issue 7 (12th May 2021)

• Record Type: Journal Article
• Authors: Mui, Jasmine; Mayne, Darren J.; Davis, Kimberley J.; Cuenca, Jose; Craig, Steven J.
• Is Part Of: ANZ journal of surgery. Volume 91:Issue 7/8(2021)
• Page Start: 1534
• Page End: 1541
• Publication Date: 2021-05-12
• Subjects: cholecystectomy -- general surgery -- hepatopancreaticobiliary surgery -- intraoperative cholangiogram -- laparoscopy -- other categories -- surgical trend; Surgery -- Periodicals; 617.005
• DOI: 10.1111/ans.16912
• Languages: English
• ISSNs: 1445-1433

Abstract

Abstract: Background: The role of routine intraoperative cholangiograms (IOCs) for prevention of bile duct injury (BDI) is contentious. There are recent reports of limited utility of IOC in preventing BDI. In Australia, IOCs are used more frequently than internationally. This study aimed to evaluate the rate of IOC use in Australia and explore potential changes in practice in light of evolving evidence for the utility of IOC. Methods: Data were collated using service item numbers in Medicare Benefits Scheme records on the Australian Government Medicare website, for services claimed between 1 January 2001 and 31 December 2019. These data were used to analyse trends in rates of IOC, cholecystectomy and BDI repair. Data were age‐standardized to account for changes in the population over time. Results: The number of IOCs claimed increased by 31.8% and cholecystectomies by 7.0% over the study period. Age‐standardized service rates per 100 000 persons increased by 5.5 and 32.6, respectively. Rates of IOC per 100 000 cholecystectomies steadily increased across the study period, while BDI repair rates remained low and erratic. Conclusion: Increasing use of IOC over the last 20 years reflects a trend towards routine rather than selective IOC; however, there is little discernible change in the number of BDIs requiring repair procedures. This suggests that routine IOC use to prevent or minimize BDI is unwarranted. Further investigation is required into the selective IOC use in high‐risk patients rather than mandatory use in all patients. Abstract : Increasing the use of IOC over the last 20 years reflects a trend towards routine rather than selective IOC. Despite this, there is little discernible change in the number of BDIs requiring repair procedures. This suggests that recommending routine IOC use to prevent or minimize BDI is unwarranted.