The National Practice Gap in Bile Duct Stone Management
Wandling and colleagues used the National Inpatient Sample to document one of the most striking practice shifts in modern general surgery: between 1998 and 2013, surgical common bile duct exploration dropped from 39.8% to 8.5% of choledocholithiasis admissions, while the two-stage ERCP-plus-cholecystectomy pathway grew to 85.7%. Notably, the single-stage laparoscopic approach was associated with a shorter risk-adjusted length of stay (3.5 vs 4.0 days). The authors warned that bile duct exploration “may be at risk of disappearing from the surgical armamentarium” — graduating residents averaged fewer than three such cases. This paper frames the central question our field is now revisiting: if one-stage care is faster for patients, what will it take — in training and in technology — to bring it back?
Citation
Wandling MW, Hungness ES, Pavey ES, et al. Nationwide assessment of trends in choledocholithiasis management in the United States from 1998 to 2013. JAMA Surg. 2016;151(12):1125-1130. doi:10.1001/jamasurg.2016.2059
