May 1, 2003
UW study finds X-ray can cut risk of surgical error
A UW study of patients across the nation who had gall bladder removals, a procedure known as cholecystectomy, shows that a major error during these operations can be cut by close to half by use of a simple test. Over 750,000 cholecystectomies are performed every year in the United States, making it the most commonly performed elective abdominal surgery procedure.
Damage to the common bile duct, a tube sitting next to the gallbladder and carrying bile from the liver to the intestine, occurs in one procedure out of 200, but complications from this damage can have life-long effects on the patient. It is the most important adverse outcome following cholecystectomy and is the number one reason for lawsuits against general surgeons.
Research done by Dr. David R. Flum, assistant professor in the UW School of Medicine’s Department of Surgery, and his colleagues and published in the April 2 edition of the Journal of the American Medical Association, shows that a simple X-ray, called a cholangiogram, can show the surgeon the location of the bile duct and is associated with a significant reduction in the rate of bile duct injury.
“This X-ray provides a road map of the bile duct,” Flum said. “While this error occurs relatively infrequently, it has a profound impact on the life of the patient, often requiring that the patient undergo more surgery to correct the problem and reconstruct the bile duct.”
The study examined the Medicare records of 1.6 million people in the United States who had cholecystectomies and found that the risk of a bile duct injury was 71 percent higher if no cholangiogram was done during the surgery.
“Taking this X-ray adds between 10 and 20 minutes to the length of the surgery, but we believe that increasing the use of cholangiograms will likely reduce the rate of this adverse outcome,” Flum said. “We’re recommending that cholangiograms be used routinely whenever possible.”
Because cholangiograms add to the length and expense of the procedure, some surgeons use them only in cases they judge to be high risk.
“When regarded from a public safety perspective, this selective use can lead to problems,” Flum said. “Like seatbelt use to prevent injury in car accidents, cholangiograms should be used all the time. In both driving a car and removing a gall bladder, we can’t really predict who is going to sustain an injury. Until we can predict who will have bile duct injuries, routine use of the cholangiogram makes the most sense.
“My colleagues and I recommend that patients planning a cholecystectomy have a discussion about cholangiogram use with their surgeons.”
