AN EXTERNAL AUDIT OF LAPAROSCOPIC CHOLECYSTECTOMY PERFORMED IN MEDICAL-TREATMENT FACILITIES OF THE DEPARTMENT-OF-DEFENSE

Objective This study provided an objective survey by an outside auditi ng group of a large, complete patient population undergoing laparoscop ic cholecystectomies, determined the frequency of complications, espec ially bile duct injuries, and presented a system for classifying and c omparing the severity of bile duct injuries. Summary Background Data T his is the first study of laparoscopic cholecystectomy to encompass a large and complete patient population and to be based on objectively c ollected data rather than self-reported data. The Civilian External Pe er Review Program (CEPRP) of the Department of Defense health care sys tem conducted a retrospective study of 5642 patients who underwent lap aroscopic cholecystectomies at 89 military medical treatment facilitie s from July 1990 through May 1992. Methods The study sample consisted of the complete records of 5607 (99.38%) of the 5642 laparoscopic chol ecystectomy patients. Results Of the sample, 6.87% of patients experie nced complications within 30 days of surgery, 0.57% sustained bile duc t injuries, and 0.5% sustained bowel injuries. Among 5154 patients who se procedures were completed laparoscopically, 5.47% experienced compl ications. Laparoscopic procedures were converted to open cholecystecto mies in 8.08% of cases. Intraoperative cholangiograms were attempted i n 46.5% of cases and completed in 80.59% of those attempts. There were no intraoperative deaths; 0.04% of the patients died within 30 days o f surgery. Conclusions The frequency of complications found in this st udy is comparable to the frequency of complications reported in recent large civilian studies and earlier, smaller studies. The authors pres ent a system for classifying bile duct injuries, which is designed to standardize references to such injuries and allow for accurate compari son of bile duct injuries in the future.