Increasing use of intraoperative cholangiogram in Australia: is it evidence‐based?

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.

Gallbladder-associated hospital admission and cholecystectomy rates across Australia and Aotearoa New Zealand (2004̫2019): Are we over-intervening?

“…Simply, ICD-10 codes could be utilized differently in the Australian and NZ institutions or reported differently by the AIHW and MHNZ, in addition to procedural codes. Although we were unable to report on private hospital rates separately in our study, recent Australian data by Mui et al [ 43 ] has done so. They noted 120 procedures per 100,000 in 2019 in the Australian private sector which would account for approximately 43% of total Australian cholecystectomies in 2019, compared to 23% in NZ.…”

Intraoperative Cholangiography in Laparoscopic Cholecystectomy: A Systematic Review and Meta-Analysis

“…29 An Australian study of The Medicare Benefits Scheme that analyzed trends of IOC, cholecystectomy, and BDI repair between January 1, 2001 and December 31, 2019 revealed a 31.8% increase in IOCs performed despite only a 7.0% increase in cholecystectomies. 30 Additionally, there was a minimal change in the number of BDIs and thereby claimed that use of routine IOC to prevent or minimise BDI was unwarranted. 30 A factor which may confound the results is that with routine cholangiography, the surgeon becomes more experienced and is more likely to perform it well and safely.…”

“…30 Additionally, there was a minimal change in the number of BDIs and thereby claimed that use of routine IOC to prevent or minimise BDI was unwarranted. 30 A factor which may confound the results is that with routine cholangiography, the surgeon becomes more experienced and is more likely to perform it well and safely. 31 Surgeons who do not perform IOC routinely may find the procedure difficult and consequently this may increase the potential for injury and misinterpretation.…”

Incidental Intraoperatively Detected Choledocholithiasis: A General Surgeon’s Approach to Management

“…Secondary aims include identifying reliable pre-operative factors to predict choledocholithiasis based on clinical, radiological, and biochemical factors. Given the varying adoption of the practice of routine IOC, with rates ranging from 20% to 82% [ 7 ], we aim to define the frequency of IOC showing stones when there is no pre-operative suggestion on radiological grounds, exploring the benefits of routine IOC. Additionally, we will analyse the indications and histopathology of all cholecystectomies.…”