Factors affecting length of stay after percutaneous biliary interventions

Abstract

Objective:: To evaluate the factors affecting the length of hospital stay (LOS) after percutaneous transhepatic biliary drainage (PTBD).

Methods:: A retrospective review of all patients who had undergone PTBD with or without stenting at a UK specialist centre between 2005 and 2016 was conducted.

Results:: 692 patients underwent 1976 procedures over 731 clinical episodes for which, the median age was 65 (range 18-100) years, and the median Charlson Index was 3. PTBD was performed for malignant (n = 563) and benign strictures (n = 60), stones (n = 62), and bile leaks (n = 46). The median LOS was 13 (range 0-157) days, and the median interprocedure duration was 9 (range 0-304) days. The median number of procedures per patient was 2 and the median number of days required to complete a set of procedures for a patient (TBID) ranged from 0 to 557 days, with a median of 16 (interquartile range: 8-32) days. Patients with biliary leak had the highest LOS. Biliary stents were mostly placed at the second stage at a median of 6 (range 0-120) days from the first procedure day. Placement of a biliary stent in the first stage of the procedure was associated with shorter LOS (p < 0.001).

Conclusions:: Biliary stenting at index procedure reduces LOS, although it is not always technically possible. Patients with bile leak managed with PTBD have longer LOS.

Advances in knowledge:: This study provides data which can help in appropriate consenting, better planning, and efficient resource utilization for patients undergoing PTBD.

Figure 1.

Schematic representation of LOS, TBID and IPD. Comparison of two patients who have undergone three biliary procedure. IPD, inter procedure duration; LOS, length of hospital stay; TBID, total biliary intervention duration.

Figure 2.

Percutaneous biliary data capture. (a) 692 patients who underwent percutaneous biliary intervention between January 2005 December 2016. (b) Categaration of diagnosis into malignant, benign, post-opearative and biliary stone.

Figure 3.

Percutneous biliary procedure. (a) Type of procedures: draininsertion. stent insertion: check cholangiogram ± drain exchange/removal; drain or stone extraction. (b) Procedure per patient.

Figure 4.

Percetneous biliary intervention outcome. (a) Stent placement in diffrent stages (1–6). “stage of stent placement” was defined by the first procedure where a stent was placed. (b) Clinical outcome measured by initial, final and daily diminution of bilirubin in micromole/litre.

Figure 5.

LOS for patients undergoing percutaneous biliary interventions startified according to the number of biliary interventions. LOS, length of hospital stay.

Figure 6.

TBID representing the total number of days between the first procedure and discharge after the final procedure. TBID, total biliary intervention duration.

Figure 7.

IPD representing the time period between each procedure. IPD, interprocedure duration.