Incidence of hepaticojejunostomy stricture after hepaticojejunostomy

Francesca M. Dimou, Deepak Adhikari, Hemalkumar Mehta, Kelly Olino, Taylor S. Riall, Kimberly M. Brown

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background: Operations requiring biliary-enteric anastomosis are uncommon, and the true incidence of postoperative stricture is unknown. Our goal was to determine the timing, incidence, and management of stricture after biliary-enteric anastomosis. Methods: We used 5% Medicare claims data (1996-2011) to identify patients ≥66 years who underwent an operation requiring a biliary-enteric anastomosis. A cumulative incidence curve was used to describe timing of stricture diagnosis. The use of imaging and intervention was evaluated. A Cox proportional hazards model was constructed to identify factors associated with stricture. Results: A total of 3,374 patients underwent an operation requiring either a hepaticojejunostomy (54.33%; N = 1,833) or choledochojejunostomy (45.67%; N = 1,541); 2-year survival was 57.0%. Overall, 403 (11.9%) patients developed a stricture. The cumulative incidence of stricture was 12.5% at 2 years. Mean time to stricture diagnosis was 16.8 ± 21.6 months (median = 8.5 months); 23% of patients with a stricture required hospitalization for cholangitis (N = 94). Only 18 (4.5%) patients with a stricture required reoperation. Younger age (hazard ratio 0.98; 95% confidence interval 0.98-0.99) was associated with a decreased likelihood of stricture formation; presence of an endostent (hazard ratio 1.66; 95% confidence interval 1.35-2.04) predicted stricture formation. Conclusion: Biliary-enteric anastomotic strictures occur with significant frequency after a biliary-enteric anastomosis. Although many patients are managed nonoperatively, stricture diagnosis remains burdensome.

Original languageEnglish (US)
JournalSurgery (United States)
DOIs
StateAccepted/In press - 2016

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Pathologic Constriction
Incidence
Choledochostomy
Confidence Intervals
Cholangitis
Medicare
Reoperation
Proportional Hazards Models
Hospitalization
Survival

ASJC Scopus subject areas

  • Surgery

Cite this

Dimou, F. M., Adhikari, D., Mehta, H., Olino, K., Riall, T. S., & Brown, K. M. (Accepted/In press). Incidence of hepaticojejunostomy stricture after hepaticojejunostomy. Surgery (United States). https://doi.org/10.1016/j.surg.2016.05.021

Incidence of hepaticojejunostomy stricture after hepaticojejunostomy. / Dimou, Francesca M.; Adhikari, Deepak; Mehta, Hemalkumar; Olino, Kelly; Riall, Taylor S.; Brown, Kimberly M.

In: Surgery (United States), 2016.

Research output: Contribution to journalArticle

Dimou, Francesca M. ; Adhikari, Deepak ; Mehta, Hemalkumar ; Olino, Kelly ; Riall, Taylor S. ; Brown, Kimberly M. / Incidence of hepaticojejunostomy stricture after hepaticojejunostomy. In: Surgery (United States). 2016.
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abstract = "Background: Operations requiring biliary-enteric anastomosis are uncommon, and the true incidence of postoperative stricture is unknown. Our goal was to determine the timing, incidence, and management of stricture after biliary-enteric anastomosis. Methods: We used 5{\%} Medicare claims data (1996-2011) to identify patients ≥66 years who underwent an operation requiring a biliary-enteric anastomosis. A cumulative incidence curve was used to describe timing of stricture diagnosis. The use of imaging and intervention was evaluated. A Cox proportional hazards model was constructed to identify factors associated with stricture. Results: A total of 3,374 patients underwent an operation requiring either a hepaticojejunostomy (54.33{\%}; N = 1,833) or choledochojejunostomy (45.67{\%}; N = 1,541); 2-year survival was 57.0{\%}. Overall, 403 (11.9{\%}) patients developed a stricture. The cumulative incidence of stricture was 12.5{\%} at 2 years. Mean time to stricture diagnosis was 16.8 ± 21.6 months (median = 8.5 months); 23{\%} of patients with a stricture required hospitalization for cholangitis (N = 94). Only 18 (4.5{\%}) patients with a stricture required reoperation. Younger age (hazard ratio 0.98; 95{\%} confidence interval 0.98-0.99) was associated with a decreased likelihood of stricture formation; presence of an endostent (hazard ratio 1.66; 95{\%} confidence interval 1.35-2.04) predicted stricture formation. Conclusion: Biliary-enteric anastomotic strictures occur with significant frequency after a biliary-enteric anastomosis. Although many patients are managed nonoperatively, stricture diagnosis remains burdensome.",
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N2 - Background: Operations requiring biliary-enteric anastomosis are uncommon, and the true incidence of postoperative stricture is unknown. Our goal was to determine the timing, incidence, and management of stricture after biliary-enteric anastomosis. Methods: We used 5% Medicare claims data (1996-2011) to identify patients ≥66 years who underwent an operation requiring a biliary-enteric anastomosis. A cumulative incidence curve was used to describe timing of stricture diagnosis. The use of imaging and intervention was evaluated. A Cox proportional hazards model was constructed to identify factors associated with stricture. Results: A total of 3,374 patients underwent an operation requiring either a hepaticojejunostomy (54.33%; N = 1,833) or choledochojejunostomy (45.67%; N = 1,541); 2-year survival was 57.0%. Overall, 403 (11.9%) patients developed a stricture. The cumulative incidence of stricture was 12.5% at 2 years. Mean time to stricture diagnosis was 16.8 ± 21.6 months (median = 8.5 months); 23% of patients with a stricture required hospitalization for cholangitis (N = 94). Only 18 (4.5%) patients with a stricture required reoperation. Younger age (hazard ratio 0.98; 95% confidence interval 0.98-0.99) was associated with a decreased likelihood of stricture formation; presence of an endostent (hazard ratio 1.66; 95% confidence interval 1.35-2.04) predicted stricture formation. Conclusion: Biliary-enteric anastomotic strictures occur with significant frequency after a biliary-enteric anastomosis. Although many patients are managed nonoperatively, stricture diagnosis remains burdensome.

AB - Background: Operations requiring biliary-enteric anastomosis are uncommon, and the true incidence of postoperative stricture is unknown. Our goal was to determine the timing, incidence, and management of stricture after biliary-enteric anastomosis. Methods: We used 5% Medicare claims data (1996-2011) to identify patients ≥66 years who underwent an operation requiring a biliary-enteric anastomosis. A cumulative incidence curve was used to describe timing of stricture diagnosis. The use of imaging and intervention was evaluated. A Cox proportional hazards model was constructed to identify factors associated with stricture. Results: A total of 3,374 patients underwent an operation requiring either a hepaticojejunostomy (54.33%; N = 1,833) or choledochojejunostomy (45.67%; N = 1,541); 2-year survival was 57.0%. Overall, 403 (11.9%) patients developed a stricture. The cumulative incidence of stricture was 12.5% at 2 years. Mean time to stricture diagnosis was 16.8 ± 21.6 months (median = 8.5 months); 23% of patients with a stricture required hospitalization for cholangitis (N = 94). Only 18 (4.5%) patients with a stricture required reoperation. Younger age (hazard ratio 0.98; 95% confidence interval 0.98-0.99) was associated with a decreased likelihood of stricture formation; presence of an endostent (hazard ratio 1.66; 95% confidence interval 1.35-2.04) predicted stricture formation. Conclusion: Biliary-enteric anastomotic strictures occur with significant frequency after a biliary-enteric anastomosis. Although many patients are managed nonoperatively, stricture diagnosis remains burdensome.

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