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July 23/30, 2003

Intraoperative Cholangiography and Risk of Common Bile Duct Injury

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;290(4):459-460. doi:10.1001/jama.290.4.459-a

In Reply: In response to Dr Livingston, we believe the NNT of 526 to avoid 1 case of CBDI is quite favorable compared with other safety interventions that have been incorporated into standard medical care (eg, standardization of instruments in machines used to deliver anesthetic gases) or into society in general (eg, mandatory use of seat belts). It is up to the community of surgeons, patients, and those who are paying for their care to determine if the use of a largely benign intervention in approximately 500 patients to prevent a life-threatening complication in a single patient is a reasonable trade-off. Furthermore, informal calculations of costs are susceptible to bias that cannot be fully assessed, and thus they tend to reflect the baseline assumptions of the calculations. More formalized cost analyses also make assumptions about cost and probability of events but allow for more systematic discussion and critique.

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