Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
To the Editor: Dr Flum and colleagues1 found that intraoperative cholangiography (IOC)
during cholecystectomy decreased the rate of common bile duct injury (CBDI)
from 0.58% to 0.39%. From these results one can compute an absolute risk reduction
of 0.0019, and a number needed to treat (NNT) of 526. That is, 526 patients
would need to have IOC (each with approximately one half hour of extra operating
room time, the expense of a radiology technician, radiologist, and prorated
cost of the fluoroscope and supplies) to avoid a single case of CBDI. The
authors also do not consider the risk of complications from IOC and its added
time under anesthesia.
Livingston EH. Intraoperative Cholangiography and Risk of Common Bile Duct Injury—Reply. JAMA. 2003;290(4):459-460. doi:10.1001/jama.290.4.459-a