Effect of hospital teaching status on endoscopic retrograde cholangiopancreatography mortality and complications in the USA

Rotundo, Laura; Afridi, Faiz; Feurdean, Mirela; Ahlawat, Sushil

doi:10.1007/s00464-020-07403-z

Cited by 9 publications

(16 citation statements)

References 26 publications

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“…5,32,33 A recent study utilizing the NIS database from 2008 to 2012 found a higher mortality associated with ERCPs in teaching hospitals but no significant difference in the rate of PEP. 34 On the contrary, a recent prospective study did not show any differences in procedural adverse events with the involvement of trainees. 35 In fact, the rate of moderately severe or severe adverse events was significantly lower in the trainee group in this study.…”

Section: Discussionmentioning

confidence: 89%

“…There are conflicting data with regard to the success and safety profile of ERCPs with involvement of trainees [5,32,33]. A recent study utilizing the NIS database from 2008 to 2012 found higher mortality associated with ERCPs in teaching hospitals but no significant difference in the rate of PEP [34]. In contrast, a recent prospective study did not show any differences in procedural adverse events for ERCPs with trainee involvement [35].…”

Section: Hospital Outcomesmentioning

confidence: 99%

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Temporal trends and mortality of post-ERCP pancreatitis in the United States: a nationwide analysis

Mutneja

Vohra

et al. 2020

Endoscopy

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BACKGROUND AND STUDY AIMS: Post-ERCP pancreatitis (PEP) is the most common and serious complication of ERCPs. Our aim was to estimate the nationwide incidence, temporal trends and mortality of PEP and establish its risk-factors in the United States. METHODS: This was a retrospective cohort study analyzing the Nationwide Inpatient Sample (NIS) data from 2011 to 2017 using ICD codes. The primary outcomes were to assess the trends of post-ERCP pancreatitis (PEP) and the predictors of occurrence of PEP. Secondary outcomes were in-hospital mortality, length of stay and ICU admission. RESULTS: Of the 1,222,467 adult patients who underwent inpatient ERCP during the study period, 55,225 (4.5%) developed post-ERCP pancreatitis. The hospital admission rate of PEP increased by 13.3% from 7,735 in 2011 to 8,920 in 2017 (OR 1.23, 95% CI 1.04-1.46; p = 0.016). The overall rate of mortality increased from 2.75% of PEP cases in 2011 to 4.38% in 2017 (OR: 1.62, 95% CI 1.10-2.38, p = 0.014). Multiple patient-related (alcohol use, cocaine use, obesity, chronic kidney disease, heart failure), procedure-related (therapeutic ERCP, sphincterotomy, pancreatic duct stent placement, sphincter of Oddi dysfunction) and hospital-related factors (teaching hospitals, hospitals located in West and Mid-west) that impact the occurrence of PEP were identified. CONCLUSIONS: Our study shows a rising hospital admission rate and mortality associated with PEP in the United States. This calls for a greater recognition of this life-threatening complication and amelioration of its risk-factors, whenever possible.

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Section: Discussionmentioning

confidence: 89%

Section: Hospital Outcomesmentioning

confidence: 99%

Temporal trends and mortality of post-ERCP pancreatitis in the United States: a nationwide analysis

Mutneja

Vohra

et al. 2020

Endoscopy

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“…ECI is a method of categorizing comorbidities on the basis of the International Classification of Diseases, which calculates a weighted sum of each of the presence of 29 binary comorbidities[ 10 ]. ECI uses 29 of the Agency for Healthcare Research and Quality comorbidity indicators to predict hospital use and in-hospital mortality[ 11 , 12 ]. In our study, the ECI score ranged from -21 to 44, with a mean score of 3.…”

Section: Methodsmentioning

confidence: 99%

Cannabis use history is associated with increased prevalence of ascites among patients with nonalcoholic fatty liver disease: A nationwide analysis

Choi

Weiss

Nasir

et al. 2020

WJH

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BACKGROUND Recent studies have revealed the endocannabinoid system as a potential therapeutic target in the management of nonalcoholic fatty liver disease (NAFLD). Cannabis use is associated with reduced risk for NAFLD, we hypothesized that cannabis use would be associated with less liver-related clinical complications in patients with NAFLD. AIM To assess the effects of cannabis use on liver-related clinical outcomes in hospitalized patients with NAFLD. METHODS We performed a retrospective matched cohort study based on querying the 2014 National Inpatient Sample (NIS) for hospitalizations of adults with a diagnosis of NAFLD. The NIS database is publicly available and the largest all-payer inpatient database in the United States. The patients with cannabis use were selected as cases and those without cannabis were selected as controls. Case-control matching at a ratio of one case to two controls was performed based on sex, age, race, and comorbidities. The liver-related outcomes such as portal hypertension, ascites, varices and variceal bleeding, and cirrhosis were compared between the groups. RESULTS A total of 49911 weighed hospitalizations with a diagnosis of NAFLD were identified. Of these, 3820 cases were selected as the cannabis group, and 7625 non-cannabis cases were matched as controls. Patients with cannabis use had a higher prevalence of ascites (4.5% vs 3.6%), with and without cannabis use, P = 0.03. The prevalence of portal hypertension (2.1% vs 2.2%), varices and variceal bleeding (1.3% vs 1.7%), and cirrhosis (3.7% vs 3.6%) was not different between the groups, with and without cannabis use, all P > 0.05. Hyperlipidemia, race/ethnicity other than White, Black, Asian, Pacific Islander or Native American, and higher comorbidity score were independent risk factors for ascites in the cannabis group. Among non-cannabis users, obesity and hyperlipidemia were independent protective factors against ascites while older age, Native American and higher comorbidity index were independent risk factors for ascites. CONCLUSION Cannabis was associated with higher rates of ascites, but there was no statistical difference in the prevalence of portal hypertension, varices and variceal bleeding, and cirrhosis.

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“…ERCP is now predominantly considered an interventional procedure (endoscopic sphincterotomy, papillotomy, biliary stone removal and insertion of biliary stents). Diagnostic ERCP rarely causes PPB with a rate of 0.3%-1.66% reported[ 21 - 25 ].…”

Section: Diagnostic Endoscopic Proceduresmentioning

confidence: 99%

“…In all of the studies, PPB was most commonly observed in diagnostic ERCP when sphincterotomy was required to obtain better access. Sphincterotomy is associated with an up to five-fold increased risk of PPB[ 21 , 23 - 25 ] and will be discussed further in the “ERCP with sphincterotomy” section (Table 9 ).…”

Section: Diagnostic Endoscopic Proceduresmentioning

confidence: 99%

Anticoagulation and antiplatelet management in gastrointestinal endoscopy: A review of current evidence

Chan

Philpott

Lim

et al. 2020

WJGE

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The role of endoscopic procedures, in both diagnostic and therapeutic purposes is continually expanding and evolving rapidly. In this context, endoscopists will encounter patients prescribed on anticoagulant and antiplatelet medications frequently. This poses an increased risk of intraprocedural and delayed gastrointestinal bleeding. Thus, there is now greater importance on optimal pre, peri and post-operative management of anticoagulant and/or antiplatelet therapy to minimise the risk of post-procedural bleeding, without increasing the risk of a thromboembolic event as a consequence of therapy interruption. Currently, there are position statements and guidelines from the major gastroenterology societies. These are available to assist endoscopists with an evidenced-based systematic approach to anticoagulant and/or antiplatelet management in endoscopic procedures, to ensure optimal patient safety. However, since the publication of these guidelines, there is emerging evidence not previously considered in the recommendations that may warrant changes to our current clinical practices. Most notably and divergent from current position statements, is a growing concern regarding the use of heparin bridging therapy during warfarin cessation and its associated risk of increased bleeding, suggestive that this practice should be avoided. In addition, there is emerging evidence that anticoagulant and/or antiplatelet therapy may be safe to be continued in cold snare polypectomy for small polyps (< 10 mm).

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Effect of hospital teaching status on endoscopic retrograde cholangiopancreatography mortality and complications in the USA

Cited by 9 publications

References 26 publications

Temporal trends and mortality of post-ERCP pancreatitis in the United States: a nationwide analysis

Temporal trends and mortality of post-ERCP pancreatitis in the United States: a nationwide analysis

Cannabis use history is associated with increased prevalence of ascites among patients with nonalcoholic fatty liver disease: A nationwide analysis

Anticoagulation and antiplatelet management in gastrointestinal endoscopy: A review of current evidence

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