Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
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.
Flum DR, Dellinger EP, Chan L. Intraoperative Cholangiography and Risk of Common Bile Duct Injury. JAMA. 2003;290(4):459-460. doi:10.1001/jama.290.4.459-a