Routine versus selective intraoperative cholangiography during cholecystectomy : systematic review, meta-analysis and health economic model analysis of iatrogenic bile duct injury
(2021) In BJS Open 5(2).- Abstract
BACKGROUND: Bile duct injury (BDI) is a severe complication following cholecystectomy. Early recognition and treatment of BDI has been shown to reduce costs and improve patients' quality of life. The aim of this study was to assess the effect and cost-effectiveness of routine versus selective intraoperative cholangiography (IOC) in cholecystectomy. METHODS: A systematic review and meta-analysis, combined with a health economic model analysis in the Swedish setting, was performed. Costs per quality-adjusted life-year (QALY) for routine versus selective IOC during cholecystectomy for different scenarios were calculated. RESULTS: In this meta-analysis, eight studies with more than 2 million patients subjected to cholecystectomy and 9000... (More)
BACKGROUND: Bile duct injury (BDI) is a severe complication following cholecystectomy. Early recognition and treatment of BDI has been shown to reduce costs and improve patients' quality of life. The aim of this study was to assess the effect and cost-effectiveness of routine versus selective intraoperative cholangiography (IOC) in cholecystectomy. METHODS: A systematic review and meta-analysis, combined with a health economic model analysis in the Swedish setting, was performed. Costs per quality-adjusted life-year (QALY) for routine versus selective IOC during cholecystectomy for different scenarios were calculated. RESULTS: In this meta-analysis, eight studies with more than 2 million patients subjected to cholecystectomy and 9000 BDIs were included. The rate of BDI was estimated to 0.36 per cent when IOC was performed routinely, compared with to 0.53 per cent when used selectively, indicating an increased risk for BDI of 43 per cent when IOC was used selectively (odds ratio 1.43, 95 per cent c.i. 1.22 to 1.67). The model analysis estimated that seven injuries were avoided annually by routine IOC in Sweden, a population of 10 million. Over a 10-year period, 33 QALYs would be gained at an approximate net cost of €808 000 , at a cost per QALY of about €24 900. CONCLUSION: Routine IOC during cholecystectomy reduces the risk of BDI compared with the selective strategy and is a potentially cost-effective intervention.
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- author
- Rystedt, J. M.L. LU ; Wiss, J. ; Adolfsson, J. ; Enochsson, L. ; Hallerbäck, B. ; Johansson, P. ; Jönsson, C. ; Leander, P. LU ; Österberg, J. and Montgomery, A. LU
- organization
- publishing date
- 2021
- type
- Contribution to journal
- publication status
- published
- subject
- in
- BJS Open
- volume
- 5
- issue
- 2
- publisher
- Wiley
- external identifiers
-
- scopus:85102905998
- pmid:33688957
- ISSN
- 2474-9842
- DOI
- 10.1093/bjsopen/zraa032
- language
- English
- LU publication?
- yes
- id
- a018ecf9-0fa4-4afd-9d76-59815b206ac8
- date added to LUP
- 2021-03-31 09:45:51
- date last changed
- 2024-06-15 08:59:29
@article{a018ecf9-0fa4-4afd-9d76-59815b206ac8,
abstract = {{<p>BACKGROUND: Bile duct injury (BDI) is a severe complication following cholecystectomy. Early recognition and treatment of BDI has been shown to reduce costs and improve patients' quality of life. The aim of this study was to assess the effect and cost-effectiveness of routine versus selective intraoperative cholangiography (IOC) in cholecystectomy. METHODS: A systematic review and meta-analysis, combined with a health economic model analysis in the Swedish setting, was performed. Costs per quality-adjusted life-year (QALY) for routine versus selective IOC during cholecystectomy for different scenarios were calculated. RESULTS: In this meta-analysis, eight studies with more than 2 million patients subjected to cholecystectomy and 9000 BDIs were included. The rate of BDI was estimated to 0.36 per cent when IOC was performed routinely, compared with to 0.53 per cent when used selectively, indicating an increased risk for BDI of 43 per cent when IOC was used selectively (odds ratio 1.43, 95 per cent c.i. 1.22 to 1.67). The model analysis estimated that seven injuries were avoided annually by routine IOC in Sweden, a population of 10 million. Over a 10-year period, 33 QALYs would be gained at an approximate net cost of €808 000 , at a cost per QALY of about €24 900. CONCLUSION: Routine IOC during cholecystectomy reduces the risk of BDI compared with the selective strategy and is a potentially cost-effective intervention.</p>}},
author = {{Rystedt, J. M.L. and Wiss, J. and Adolfsson, J. and Enochsson, L. and Hallerbäck, B. and Johansson, P. and Jönsson, C. and Leander, P. and Österberg, J. and Montgomery, A.}},
issn = {{2474-9842}},
language = {{eng}},
number = {{2}},
publisher = {{Wiley}},
series = {{BJS Open}},
title = {{Routine versus selective intraoperative cholangiography during cholecystectomy : systematic review, meta-analysis and health economic model analysis of iatrogenic bile duct injury}},
url = {{http://dx.doi.org/10.1093/bjsopen/zraa032}},
doi = {{10.1093/bjsopen/zraa032}},
volume = {{5}},
year = {{2021}},
}