|OB06 Biliary: Miscellaneous
|Selection of Presentations from Abstract Submissions
|OB06-01 ||Impact of Iatrogenic Biliary Injury during Laparoscopic Cholecystectomy on Surgeon's Mental Distress: A Nationwide Survey from China
Tian Yang, China
H.-S. Dai1, L. Liang2, C.-C. Zhang1, Z.-J. Cheng3, Y.-H. Peng4, X.-P. Geng5, H.-J. Qing6, Y. Lau Wan7, T. Yang8
1Southwest Hospital, Third Military Medical University (Army Medical University), China, 2Eastern Hepatobiliary Surgery Hospital, China, 3Zhongda Hospital, School of Medicine, Southeast University, China, 4Mianyang Center Hospital, China, 5The First Affiliated Hospital of Anhui Medical University, China, 6Armed Police Crops Hospital of Sichuan Province, China, 7Chinese University of Hong Kong, Prince of Wales Hospital, China, 8Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, China
Background: Iatrogenic biliary injury (IBI) following
laparoscopic cholecystectomy (LC) is the most common and recognized iatrogenic
complications. Little is known whether LC-IBI would lead to surgeon's mental
distress. This study reports the incidence of surgeon's mental distress who
have caused LC-IBI and risk factors of surgeon's severe mental distress (SMD).
Methods: A cross-sectional survey in the form of electronic
questionnaire was conducted among Chinese general surgeons who have caused
LC-IBI. The six collected clinical features relating to mental distress
1) feeling burnout, anxiety, or depression,
2) avoiding performing
3) having physical reactions when recalling the incidence,
4) having the
urge to quit surgery,
5) taking psychiatric medications, and
professional psychological counseling.
Univariable and multivariable analyses
were performed to identify risk factors of SMD, which was defined as meeting ≥
3 of the above-mentioned clinical features.
Among 1,466 surveyed surgeons,
1,236(84.3%) experienced mental distress following LC-IBI, and nearly half (49.7%, 614/1236) had SMD. Multivariable
analyses demonstrated that surgeons from non-university affiliated hospitals (OR:1.873),
patients who required multiple repair operations (OR:4.075), patients who
required hepaticojejunostomy/partial hepatectomy (OR:1.859), existing
lawsuit litigation (OR:10.491), existing violent
doctor-patient conflicts (OR:4.995), needing surgeons'
personal compensation (OR:2.531), and additional administrative
punishment by hospitals (OR:2.324) were independent risk
factors of surgeon's SMD.
Conclusion: Four out of five surgeons experienced mental
distress following LC-IBI, and nearly half had SMD. Several independent risk
factors of SMD were identified, which could help to make strategies to improve
mental well-being of these surgeons.
[Figure.Numbers of valid questionnaires from different districts in China.]
|OB06-02 ||The Upper Gastrointestinal Cancer Registry: Biliary Cancer Clinical Quality Registry Pilot Results
Charles Henry Caldow Pilgrim, Australia
C.H.C. Pilgrim1,2, J.F. Holland1, T. Muhlen-Schulte1, M. Quinn1, J.R. Zalcberg1,2, UGICR Hepatopancreatobiliary Working Party and UGICR contributors
1Monash University, Australia, 2Alfred Health, Australia
Introduction: The Upper Gastrointestinal Cancer Registry
(UGICR) is a multi-modular clinical quality registry established to measure and
report on the quality of care provided to people with newly diagnosed cancer
arising from the pancreas, oesophagus, stomach, liver and biliary system. The
aim of the biliary module pilot was to trial data collection for a quality
indicator (QI) set; analyse pilot data and use results to review and refine the
Methods: The UGICR's hepatopancreatobiliary (HPB) working party reviewed the
existing literature and clinical practice guidelines, to develop a provisional
set of QIs. Participants with hilar cholangiocarcinoma, intrahepatic
cholangiocarcinoma or gallbladder cancer were recruited from Victorian UGICR
participating sites. Pilot data were abstracted from medical records and
preliminary data analysis conducted. Pilot data collection is due for
Results: A set of 19 QIs covering the patient care pathway from referral through
to end-of-life care were developed. Data collection for over 150 participants
recruited to the pilot is nearly complete. Mid-pilot results for three QIs show:
35% of patients had documented disease specific gold standard imaging prior to
treatment; 74% of patients had disease management discussed at
multi-disciplinary team meeting; and 92% of patients were referred to palliative
Conclusion: The UGICR biliary module pilot data will be used to inform the
selection of a final set of QIs. Once sufficiently mature, risk-adjusted
benchmarked QI reports will be provided to participating sites, with the
intention of reducing unwarranted variation in the quality of care received by
patients with biliary cancer.
|OB06-04 ||What Are the Long-term Clinical and Economic Consequences of Delayed Biliary Strictures after Cholecystectomy?
James Halle-Smith, United Kingdom
J. Halle-Smith1, R. Marudanayagam2, R. Sutcliffe1, J. Isaac1, D. Mirza1, K. Roberts1
1HPB and Transplant Unit, Queen Elizabeth Hospital Birmingham, United Kingdom, 2Queen Elizabeth Hospital Birmingham, United Kingdom
Introduction: Delayed biliary stricture after cholecystectomy is a rare complication for which little is known of the aetiology or long-term
clinical and economic consequences. The aims of this study were to investigate
the risk factors, clinical outcomes and economic impact of this rare but
Method: Patients who developed a delayed biliary stricture after
cholecystectomy were identified from a prospectively collected and maintained database.
Risk factors for stricture development, long-term biliary complication rates,
quality of life and complete treatment and follow-up costs were investigated
for each patient.
Results: Some 44 patients were identified, of whom N=17,12
and 3 developed hilar, subhilar, and sectoral biliary strictures respectively.
Patients were commonly treated with Roux-en-Y hepaticojejunostomy (90%) and
followed up for a median of 8.9 years (IQR5.8-14.8) during which time 16 (36%)
developed biliary complications and 5 (11%) patients died. Costs of all operations,
interventional radiology and diagnostic imaging were assimilated and the mean
cost of treatment and follow-up was £14,309.26 per patient, similar to
previously reported costs for major bile duct injury. Both general and disease-specific
quality of life were assessed using the SF-36 tool and EORTC QLQ-C30 with Bil21
add-on. Scores were statistically similar for patients with delayed biliary stricture
and those with bile duct injury.
Conclusions: Delayed biliary strictures may
develop after uneventful cholecystectomy and are typically managed with biliary
reconstruction. They are serious complications that lead to considerable
long-term morbidity and costs to the health service, similar to those previously reported
for major bile duct injury.