Texas statewide incidence and severity of iatrogenic major vascular injury during inpatient laparoscopic surgery: a population-based cohort study.

BACKGROUND

Major vascular injury during laparoscopic surgery is rare but potentially catastrophic. Existing literature is largely limited to case series and registry-based analyses without reliable denominators or validated measures of disease severity. Procedure-specific risk and overall population burden remain incompletely defined. This study aimed to determine the statewide incidence, severity profile, and procedure-specific risk of iatrogenic major vascular injury during inpatient laparoscopic surgery.

METHODS

We conducted a retrospective population-based cohort study using the 2024 Texas Inpatient and Outpatient Public Use Data File (PUDF). Adult patients (≥ 18 years) undergoing inpatient laparoscopic procedures were identified using ICD-10-PCS approach codes. Iatrogenic major vascular injury was defined using ICD-10-CM diagnosis codes T81.71* and/or I97.5*. The primary outcome was statewide incidence per 10,000 inpatient laparoscopic procedures. Secondary outcomes included markers of clinical severity, including mortality, ICU admission, conversion to open surgery, transfusion, organ failure, and length of stay.

RESULTS

Among 119,652 inpatient laparoscopic procedures, 84 cases of iatrogenic major vascular injury were identified, yielding an incidence of 7.02 per 10,000 procedures. (R3C3) These injuries were associated with high clinical severity, including an in-hospital mortality rate of 7.2% and ICU admission in 66.3% of cases. Surgical management often required escalation, with 55.4% of cases undergoing conversion to open surgery and 30.1% requiring blood transfusion. Acute kidney injury (26.5%) and respiratory failure (24.1%) were common. The median length of stay was 6 days (IQR 3-11), compared with 3 days (IQR 1-5) without injury. Diagnostic laparoscopy demonstrated the highest incidence (20.59 per 10,000), whereas colorectal resection had the lowest (0.89 per 10,000).

CONCLUSIONS

Iatrogenic major vascular injury during inpatient laparoscopic surgery was rare but associated with substantial morbidity and mortality. The elevated incidence observed during diagnostic laparoscopy may suggest abdominal access as an important contributing mechanism of injury, reinforcing the need for continued emphasis on safe-entry techniques and heightened specialty-specific risk awareness. (R2C1).