Surgeons should know that increased use of intraoperative cholangiography (IOC) during cholecystectomy does not reduce bile duct injury rates, but it does lead to more postoperative ERCP procedures.

• Among 434,696 patients, BDI rates were low and similar across IOC use groups (0.5% for never, 0.4% for selective, and 0.4% for routine).
• Postoperative ERCP rates increased with IOC use: 8.1% for never users, 10.4% for selective, and 12.0% for routine users (all p<0.001).

Surgeons may need to reconsider the necessity and thresholds for IOC to optimize patient outcomes and resource use.