Clinical outcomes and predictors for 30‐day readmissions of endoscopic retrograde cholangiopancreatography in the United States

Abstract

Background/ObjectivesWe aimed to assess 30‐day readmissions of endoscopic retrograde cholangiopancreatography (ERCP) in the United States.MethodsThe National Readmission Database was utilized from 2016 to 2020 to identify 30‐day readmissions of ERCP. Hospitalization characteristics and outcomes were compared between index hospitalizations and readmissions. Predictors of 30‐day readmission and mortality were also identified.ResultsBetween 2016 and 2020, 885 416 index hospitalizations underwent ERCP. Of these, 88 380 (10.15%) were readmitted within 30 days. Compared to index hospitalizations, 30‐day readmissions had higher mean age (63.76 vs 60.8 years, P < 0.001) and proportion of patients with Charlson Comorbidity Index (CCI) score ≥3 (48.26% vs 29.91%, P < 0.001). Sepsis was the most common readmission diagnosis. Increasing age, male gender, higher CCI scores, admissions at large metropolitan teaching hospitals, cholecystectomy on index hospitalization, biliary stenting, increasing length of stay (LOS) at index admission, post‐ERCP pancreatitis, post‐ERCP hemorrhage, and gastrointestinal tract perforation were independent predictors of 30‐day readmissions. Furthermore, 30‐day readmissions had higher odds of inpatient mortality (4.42% vs 1.66%, aOR 1.9, 95% CI: 1.79–2.01, P < 0.001) compared to index hospitalizations. However, we noted a shorter LOS (5.78 vs 6.22 days, mean difference 1.2, 95% CI: 1.12–1.28, P < 0.001) and lower total hospital charge ($71 076 vs $93 418, mean difference $31 452, 95% CI: 29 835–33 069, P < 0.001) for 30‐day readmissions compared to index hospitalizations. Increasing age, higher CCI scores, increasing LOS, biliary stenting, and post‐ERCP hemorrhage were independent predictors of inpatient mortality for 30‐day readmissions.ConclusionAfter index ERCP, the 30‐day remission rate was 10.15%. Compared to index hospitalizations, 30‐day readmissions had higher odds of inpatient mortality.

Impact of frailty on endoscopic retrograde cholangiopancreatography outcomes in nonagenarians: A United States national experience

“…Over time, it has evolved from being primarily a diagnostic tool to a therapeutic procedure, enabling the treatment of various conditions like choledocholithiasis, acute cholangitis, bile duct strictures, etc. [ 1 , 2 ]. Both ERCP and procedures associated with therapeutic ERCP have the potential for complications, such as bleeding, pancreatitis, duodenum and pancreaticobiliary perforations, and cardiopulmonary distress[ 3 , 4 ].…”