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.

A comprehensive evaluation of the long-term economic impact of major bile duct injury / J.M. Halle-Smith, J. Hodson, L.G. Stevens, B. Dasari, R. Marudanayagam, T. Perera, R.P. Sutcliffe, P. Muiesan, J. Isaac, D.F. Mirza, K.J. Roberts. - In: HPB. - ISSN 1365-182X. - 21:10(2019), pp. 1312-1321. [10.1016/j.hpb.2019.01.018]

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

P. Muiesan;
2019

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.
Bile Duct Diseases; Bile Ducts; Cholecystectomy; Costs and Cost Analysis; Female; Follow-Up Studies; Humans; Iatrogenic Disease; Jejunostomy; Male; Middle Aged; Reoperation; Retrospective Studies; Cost of Illness; Forecasting
Settore MED/18 - Chirurgia Generale
HPB
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/883234
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