Adverse outcomes and short-term cost implications of bile duct injury during cholecystectomy



Bile duct injury (BDI) is an uncommon but major complication of cholecystectomy that has a poorly defined magnitude of effect on hospital costs. This study sought to calculate the healthcare costs, length of stay, and discharge status associated with bile duct injury in patients undergoing cholecystectomy in the United States.


The Premier Healthcare Database, which comprises hospital-billing records from over 700 hospitals in the United States, was queried for all patients undergoing cholecystectomy between January 2010 and March 2018. BDI was defined by ICD-9-CM and ICD-10-CM codes. Patient demographics, clinical characteristics, and operative information were extracted. Hospital costs, length of stay, and discharge status were compared between BDI and non-BDI patients. Propensity score matching was used to minimize confounding factors. Multivariable regression models were used to estimate the association between BDI and the outcomes variables.


A total of 1,168,288 cholecystectomies were identified. BDI occurred in 878 patients (0.08%). Laparoscopy was the most common approach (> 95%). The majority of BDI occurred during inpatient admissions (71.0%). BDI patients had higher index admission hospital costs ($18,771 vs. $12,345, p < 0.0001), increased rate of discharge to an institutional post-acute care facility (odds ratio 3.89, 95% CI 2.92–5.19, p < 0.0001), and increased risk of readmission within 30 days after discharge (odds ratio 1.86, 95% CI 1.52–2.28, p < 0.0001), compared to patients without BDI. Among inpatient cholecystectomies, BDI was associated with increased length of stay (8.6 days vs. 4.8 days, p < 0.0001).


BDI is associated with significantly increased hospital costs, length of stay, 30-day readmission, and discharge to an institutional post-acute care facility.

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The authors acknowledge data analytic support by Bidusee Ray from Mu Sigma.


No outside funding was obtained for this article.

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Correspondence to Robert C. G. Martin II.

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Dr. Wei and Mr. Johnson are employees of and have an equity interest in Johnson & Johnson, New Brunswick, NJ, USA. Dr. Patkar is an employee of and has an equity interest in Ethicon, Somerville, NJ, USA. Drs. O’Brien, Bhutiani, Rao, Vitale, and Martin have no conflicts of interest or financial ties to disclose.

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O’Brien, S., Wei, D., Bhutiani, N. et al. Adverse outcomes and short-term cost implications of bile duct injury during cholecystectomy. Surg Endosc 34, 628–635 (2020) doi:10.1007/s00464-019-06809-8

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  • Cholecystectomy
  • Complication
  • Cost