Risk Tolerance and Bile Duct Injury: Surgeon Characteristics, Risk-Taking Preference, and Common Bile Duct Injuries

• Published in: Journal of the American College of Surgeons Vol. 209; no. 1; pp. 17 - 24
• Main Authors: Massarweh, Nader N., MD, Devlin, Allison, MS, Symons, Rebecca Gaston, MPH, Broeckel Elrod, Jo Ann, PhD, Flum, David R., MD, FACS, MPH
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-07-2009; Elsevier
• Subjects: Age Factors; Bile Ducts - injuries; Biological and medical sciences; Cholecystectomy, Laparoscopic - adverse effects; Clinical Competence; Decision Making; Female; General aspects; Health participants; Humans; Iatrogenic Disease; Intraoperative Complications - epidemiology; Male; Medical sciences; Middle Aged; Practice Patterns, Physicians' - statistics & numerical data; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk Factors; Risk-Taking; Surgery; Surveys and Questionnaires; Time Factors; United States - epidemiology; United States; JPI; Jackson Personality Index; LC; laparoscopic cholecystectomy; intraoperative cholangiogram; CBDI; IOC; common bile duct injury; Biliary tract; Digestive system; Tolerance; Risk; Risk taking; Trauma; Surgeon; Medicine; Treatment; Characteristics; Preference; Surgery; Risk factor; Lesion; Main biliary tract
• ISSN: 1072-7515; 1879-1190
• DOI: 10.1016/j.jamcollsurg.2009.02.063

Background Little is known about surgeon characteristics associated with common bile duct injury (CBDI) during laparoscopic cholecystectomy (LC). Risk-taking preferences can influence physician behavior and practice. We evaluated self-reported differences in characteristics and risk-taking preference among surgeons with and without a reported history of CBDI. Study Design A mailed survey was sent to 4,100 general surgeons randomly selected from the mailing list of the American College of Surgeons. Surveys with a valid exclusion (retired, no LC experience) were considered responsive, but were excluded from data analysis. Results Forty-four percent responded (1,412 surveys analyzed), 37.7% reported being the primary surgeon when a CBDI occurred, and 12.9% had more than one injury. Surgeons reporting an injury were slightly older (52.8 ± 9.0 years versus 51.3 ± 9.8 years; p < 0.004) and in practice longer (20.8 ± 9.7 years versus 18.9 ± 10.5 years; p < 0.001). Surgeons not reporting a CBDI were more likely trained in LC during residency (63.3% versus 55.4% injuring) as compared with surgeons reporting a CBDI, who were more likely trained at an LC course (29.8% versus 38.2%). Surgeons in academic practice or who work with residents had lower reported rates of CBDI (7.9% versus 14.5% [academics]; 18.7% versus 25.0% [residents]). Mean risk score was 12.4 ± 4.4 (range 6 to 30 [30 = highest]) with a similar average between those who did (12.2 ± 4.5) and did not (11.9 ± 4.4) report a CBDI (p < 0.23). Compared with surgeons in the lowest three deciles of risk score, relative risk for CBDI among surgeons in the upper three deciles was 17% greater (p = 0.07). Conclusions More years performing LC and certain practice characteristics were associated with an increased rate of CBDI. The impact of extremes of risk-taking preference on surgical decision making can be an important part of decreasing adverse events during LC and should be evaluated.