Threefold increased bile duct injury rate is associated with less surgeon experience in an insurance claims database: More rigorous training in biliary surgery may be needed

Steven D. Schwaitzberg, Daniel J. Scott, Daniel B. Jones, Sophia K. McKinley, Johanna Castrillion, Tina D. Hunter, L. Michael Brunt

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Introduction: Bile duct injury (BDI) remains the dreaded complication of laparoscopic cholecystectomy (LC) over the last two decades. Although the Fundamentals of Laparoscopic Surgery (FLS) certification is now required for new applicants by the American Board of Surgery, the impact of FLS on procedure-specific outcomes is unknown. Moreover, the FLS content centers on fundamental education and not procedure-specific complication reduction such as BDI, magnifying the importance of understanding the educational impact of FLS on specific case types. This study reviewed the impact of FLS certification and other factors on the incidence of bile duct injury in a large insurance claims database.

Methods: In total, 53,632 LCs were reviewed from July 2009 to December 2010 from a large private payer claims database. Surgeon National Provider Identifier (NPI), FLS certification status, International Classification of Diseases, Ninth Revision (ICD-9) and Current Procedural Terminology (CPT) were available for each event. Each record was analyzed for evidence of any bile duct injury based on associated CPT or ICD-9 data in the claim record. Characteristics of the FLS+ and FLS− surgeon groups were analyzed by a separate reviewer blinded to clinical outcome on a large scale.

Results: A total of 53,632 LCs were reviewed; 1748 LC were performed by 441 FLS+ surgeons; and 58,870 LCs by 10,851 FLS- surgeons. (Some procedures involved more than one surgeon). Eighty-two BDIs were identified: 8 in the FLS+ and 74 in the FLS− group. The FLS+ group had a higher rate of BDI than the FLS− group (0.47 vs. 0.14 %, p = 0.0013); however, the FLS+ group was also younger (mean age 38.2 FLS+ vs. 50.4 years) and had significantly fewer years in practice (FLS+ = 6.1 vs. FLS− = 20.7, p = 0.0012). No other complications showed differences between the groups.

Conclusion: NPI can be used as a linking intermediary between skills certification and outcomes on claims databases. FLS certification was not associated with a reduction in bile duct injury in this analysis, but FLS+ surgeons were also younger and less experienced overall. Since FLS lacks content specific to BDI, large-scale validated training and assessment programs targeted at BDI prevention are needed to impact the rate of this complication during cholecystectomy.

Original languageEnglish (US)
Pages (from-to)3068-3073
Number of pages6
JournalSurgical Endoscopy and Other Interventional Techniques
Volume28
Issue number11
DOIs
StatePublished - Oct 21 2014

Fingerprint

Bile Ducts
Insurance
Laparoscopy
Databases
Wounds and Injuries
Certification
International Classification of Diseases
Surgeons
Current Procedural Terminology
Laparoscopic Cholecystectomy
Education
Cholecystectomy

Keywords

  • Bile duct injury
  • Comparative effectiveness of training
  • Fundamentals of Laparoscopic Surgery
  • Laparoscopic cholecystectomy
  • National Provider Identifier

ASJC Scopus subject areas

  • Surgery

Cite this

Threefold increased bile duct injury rate is associated with less surgeon experience in an insurance claims database : More rigorous training in biliary surgery may be needed. / Schwaitzberg, Steven D.; Scott, Daniel J.; Jones, Daniel B.; McKinley, Sophia K.; Castrillion, Johanna; Hunter, Tina D.; Michael Brunt, L.

In: Surgical Endoscopy and Other Interventional Techniques, Vol. 28, No. 11, 21.10.2014, p. 3068-3073.

Research output: Contribution to journalArticle

Schwaitzberg, Steven D. ; Scott, Daniel J. ; Jones, Daniel B. ; McKinley, Sophia K. ; Castrillion, Johanna ; Hunter, Tina D. ; Michael Brunt, L. / Threefold increased bile duct injury rate is associated with less surgeon experience in an insurance claims database : More rigorous training in biliary surgery may be needed. In: Surgical Endoscopy and Other Interventional Techniques. 2014 ; Vol. 28, No. 11. pp. 3068-3073.
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title = "Threefold increased bile duct injury rate is associated with less surgeon experience in an insurance claims database: More rigorous training in biliary surgery may be needed",
abstract = "Introduction: Bile duct injury (BDI) remains the dreaded complication of laparoscopic cholecystectomy (LC) over the last two decades. Although the Fundamentals of Laparoscopic Surgery (FLS) certification is now required for new applicants by the American Board of Surgery, the impact of FLS on procedure-specific outcomes is unknown. Moreover, the FLS content centers on fundamental education and not procedure-specific complication reduction such as BDI, magnifying the importance of understanding the educational impact of FLS on specific case types. This study reviewed the impact of FLS certification and other factors on the incidence of bile duct injury in a large insurance claims database.Methods: In total, 53,632 LCs were reviewed from July 2009 to December 2010 from a large private payer claims database. Surgeon National Provider Identifier (NPI), FLS certification status, International Classification of Diseases, Ninth Revision (ICD-9) and Current Procedural Terminology (CPT) were available for each event. Each record was analyzed for evidence of any bile duct injury based on associated CPT or ICD-9 data in the claim record. Characteristics of the FLS+ and FLS− surgeon groups were analyzed by a separate reviewer blinded to clinical outcome on a large scale.Results: A total of 53,632 LCs were reviewed; 1748 LC were performed by 441 FLS+ surgeons; and 58,870 LCs by 10,851 FLS- surgeons. (Some procedures involved more than one surgeon). Eighty-two BDIs were identified: 8 in the FLS+ and 74 in the FLS− group. The FLS+ group had a higher rate of BDI than the FLS− group (0.47 vs. 0.14 {\%}, p = 0.0013); however, the FLS+ group was also younger (mean age 38.2 FLS+ vs. 50.4 years) and had significantly fewer years in practice (FLS+ = 6.1 vs. FLS− = 20.7, p = 0.0012). No other complications showed differences between the groups.Conclusion: NPI can be used as a linking intermediary between skills certification and outcomes on claims databases. FLS certification was not associated with a reduction in bile duct injury in this analysis, but FLS+ surgeons were also younger and less experienced overall. Since FLS lacks content specific to BDI, large-scale validated training and assessment programs targeted at BDI prevention are needed to impact the rate of this complication during cholecystectomy.",
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T1 - Threefold increased bile duct injury rate is associated with less surgeon experience in an insurance claims database

T2 - More rigorous training in biliary surgery may be needed

AU - Schwaitzberg, Steven D.

AU - Scott, Daniel J.

AU - Jones, Daniel B.

AU - McKinley, Sophia K.

AU - Castrillion, Johanna

AU - Hunter, Tina D.

AU - Michael Brunt, L.

PY - 2014/10/21

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N2 - Introduction: Bile duct injury (BDI) remains the dreaded complication of laparoscopic cholecystectomy (LC) over the last two decades. Although the Fundamentals of Laparoscopic Surgery (FLS) certification is now required for new applicants by the American Board of Surgery, the impact of FLS on procedure-specific outcomes is unknown. Moreover, the FLS content centers on fundamental education and not procedure-specific complication reduction such as BDI, magnifying the importance of understanding the educational impact of FLS on specific case types. This study reviewed the impact of FLS certification and other factors on the incidence of bile duct injury in a large insurance claims database.Methods: In total, 53,632 LCs were reviewed from July 2009 to December 2010 from a large private payer claims database. Surgeon National Provider Identifier (NPI), FLS certification status, International Classification of Diseases, Ninth Revision (ICD-9) and Current Procedural Terminology (CPT) were available for each event. Each record was analyzed for evidence of any bile duct injury based on associated CPT or ICD-9 data in the claim record. Characteristics of the FLS+ and FLS− surgeon groups were analyzed by a separate reviewer blinded to clinical outcome on a large scale.Results: A total of 53,632 LCs were reviewed; 1748 LC were performed by 441 FLS+ surgeons; and 58,870 LCs by 10,851 FLS- surgeons. (Some procedures involved more than one surgeon). Eighty-two BDIs were identified: 8 in the FLS+ and 74 in the FLS− group. The FLS+ group had a higher rate of BDI than the FLS− group (0.47 vs. 0.14 %, p = 0.0013); however, the FLS+ group was also younger (mean age 38.2 FLS+ vs. 50.4 years) and had significantly fewer years in practice (FLS+ = 6.1 vs. FLS− = 20.7, p = 0.0012). No other complications showed differences between the groups.Conclusion: NPI can be used as a linking intermediary between skills certification and outcomes on claims databases. FLS certification was not associated with a reduction in bile duct injury in this analysis, but FLS+ surgeons were also younger and less experienced overall. Since FLS lacks content specific to BDI, large-scale validated training and assessment programs targeted at BDI prevention are needed to impact the rate of this complication during cholecystectomy.

AB - Introduction: Bile duct injury (BDI) remains the dreaded complication of laparoscopic cholecystectomy (LC) over the last two decades. Although the Fundamentals of Laparoscopic Surgery (FLS) certification is now required for new applicants by the American Board of Surgery, the impact of FLS on procedure-specific outcomes is unknown. Moreover, the FLS content centers on fundamental education and not procedure-specific complication reduction such as BDI, magnifying the importance of understanding the educational impact of FLS on specific case types. This study reviewed the impact of FLS certification and other factors on the incidence of bile duct injury in a large insurance claims database.Methods: In total, 53,632 LCs were reviewed from July 2009 to December 2010 from a large private payer claims database. Surgeon National Provider Identifier (NPI), FLS certification status, International Classification of Diseases, Ninth Revision (ICD-9) and Current Procedural Terminology (CPT) were available for each event. Each record was analyzed for evidence of any bile duct injury based on associated CPT or ICD-9 data in the claim record. Characteristics of the FLS+ and FLS− surgeon groups were analyzed by a separate reviewer blinded to clinical outcome on a large scale.Results: A total of 53,632 LCs were reviewed; 1748 LC were performed by 441 FLS+ surgeons; and 58,870 LCs by 10,851 FLS- surgeons. (Some procedures involved more than one surgeon). Eighty-two BDIs were identified: 8 in the FLS+ and 74 in the FLS− group. The FLS+ group had a higher rate of BDI than the FLS− group (0.47 vs. 0.14 %, p = 0.0013); however, the FLS+ group was also younger (mean age 38.2 FLS+ vs. 50.4 years) and had significantly fewer years in practice (FLS+ = 6.1 vs. FLS− = 20.7, p = 0.0012). No other complications showed differences between the groups.Conclusion: NPI can be used as a linking intermediary between skills certification and outcomes on claims databases. FLS certification was not associated with a reduction in bile duct injury in this analysis, but FLS+ surgeons were also younger and less experienced overall. Since FLS lacks content specific to BDI, large-scale validated training and assessment programs targeted at BDI prevention are needed to impact the rate of this complication during cholecystectomy.

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KW - Comparative effectiveness of training

KW - Fundamentals of Laparoscopic Surgery

KW - Laparoscopic cholecystectomy

KW - National Provider Identifier

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