Introduction

The sphincter of Oddi (SOD) is a valve composed of smooth muscle which helps regulate the flow of pancreaticobiliary secretions into the duodenum. SOD can involve the biliary sphincter, pancreatic sphincter, or both. Several studies have shown that patients with SOD have higher complications when undergoing endoscopic retrograde cholangiopancreatography (ERCP). This study aimed to identify risk factors that contribute to worsened in-hospital outcomes in patients with SOD undergoing ERCP as well as to identify high-risk populations. We sought to identify gender differences between these two populations because gender disparities in health care can be linked to worse health outcomes.

Aims & Methods

The National Inpatient Sample (NIS) is an extensive, publicly available all-payer inpatient care database in the USA. We distinguished between adult patients (> 18 years old) undergoing ERCP with SOD and those without SOD from the years 2010-2020. Multivariate logistic regression and linear regression analyses using the Kernel Method with propensity matching were employed to account for confounders. STATA 17 MP was used to compute the odds ratios of in-hospital mortality, average length of hospital stay (LOS), and hospital charges (TOTHC). Weights were used to generate nationally and regionally representative estimates.

Results

3,100 of the 2,176,350 patients undergoing ERCP (2010-2020) had SOD, of which a total of 2,564 female patients (82.68%) were found. Female patients had a significantly higher mortality than males (15.55% Female vs. 3.11% Male, p<0.01) as well as a higher overall mortality rate (OR 2.5, CI 2.1-2.9, p<0.0001). Additional gender disparities were found after adjusting for age, race, BMI, hospital region, hospital bed size, socioeconomic status, teaching status (teach vs. non-teach), and hospital location (urban vs. rural): female patients had higher LOS (+5.5 days, CI 4.5-6.5 days, p<0.0001) and TOTHC (+$51,856, CI $47,533-$56,179, p<0.0001) compared to male patients. Analysis of post-procedural complications is noted in Table 1.

Conclusion

Significant disparities between male and female patients were observed in this retrospective nationwide cohort of over 2.1 million patients. Female patients with SOD undergoing ERCP had higher overall mortality, mortality rate, and increased LOS and TOTHC when compared to males. Our study identified risk factors and post-procedural complications such as aspiration, perforation, sepsis, etc (outlined in Table 1) in patients with SOD undergoing ERCP that lead to worse overall outcomes. To help minimize risks and lessen the healthcare burden, the underlying causes of gender differences should be further investigated through randomized controlled trials.

Introduction

Endoscopic retrograde cholangiopancreatography (ERCP) is a universally established therapeutic modality used by endoscopists to evaluate and treat numerous pancreato-biliary diseases. Few large-scale database studies evaluate risk factors that worsen outcomes in patients undergoing ERCP. In this study, we aim to estimate in-hospital outcomes of ERCP in patients from a nationally representative database.

Aims & Methods

We retrospectively analyzed the Nationwide Inpatient Sample (NIS) database for 2015-2019. Patients with a principal diagnosis of ERCP and a secondary diagnosis of certain cardiac or pulmonary diseases [non-ST-elevation myocardial infarction (NSTEMI), pulmonary hypertension (pulmonary HTN), COPD, lung cancer, and asthma] were identified using the ICD-10 codes. The NIS, a large publicly available all-payer inpatient care database in the USA, was queried from 2015 to 2019. Multivariate regression analysis was used to calculate the odds ratios of in-hospital mortality, the average length of hospital stay (LOS), and hospital charges (TOTHC) using STATA 17 MP.

Results

Our study identified approximately 1,088,175 patients undergoing ERCP. Of these patients, 15,950 patients died (1.47%). We identified certain risk factors causing worsened in-hospital outcomes in this patient population.
On multivariate analysis, in patients undergoing ERCP, a positive predictor of increased mortality was the presence NSTEMI (OR: 4.54, p<0.0001, 95% CI: 2.64 -7.80), pulmonary HTN (OR: 3.84, p< 0.023, 95% CI:1.42 - 5.87), or COPD (OR: 1.32, p<0.024, 95% CI: 1.04 - 1.67).
LOS was increased if patients had any of the following comorbidities: NSTEMI (+5.19 days, p<0.0001, 95% CI: 3.39- 6.99), COPD (+1.75 days, p<0.0001, 95% CI: 1.50-2.00), or lung cancer (+2.29 days, p<0.004, 95% CI: 1.40 - 3.18).
TOTHC were increased in patients who had NSTEMI ($92,791.01, p<0.0001, 95% CI: $60,523.12 - $125,058.90), COPD ($11,276.42, p<0.001, 95% CI: $6,687.48 - $15,865.37) or asthma ($9,619.18, p< 0.010, 95% CI: $2,257.79 - $16,980.58).

Conclusion

We found that mortality in patients undergoing ERCP is extremely low (1.47%). Positive predictors of mortality for those undergoing ERCP were NSTEMI, pulmonary HTN, and COPD. These comorbidities are essential as early identification and treatment before ERCP can lead to improved hospital outcomes. Future prospective and randomized controlled studies are required to reduce complications and improve outcomes of ERCP in these patient populations.

Introduction

The novel coronavirus emerged in 2019 and led to a worldwide pandemic. COVID-19 had a catastrophic effect on the world’s population, resulting in millions of deaths. Our study aimed to evaluate and determine the outcomes of patients who had an underlying diagnosis of

COVID-19 and to assess overall mortality, length of stay (LOS), and total hospital charges (TOTHC) associated with patients undergoing ERCP who had a concomitant diagnosis of COVID-19.

Aims & Methods

We identified patients 18 years and older with COVID-19 undergoing ERCP versus those undergoing ERCP only from the National Inpatient Sample (NIS) from 2020. The NIS is a large publicly available all-payer inpatient care database in the USA. Using STATA 17 MP, multivariate regression analysis was used to calculate the odds ratios of in-hospital mortality, the average LOS, and TOTHC.

Results

We identified 1,685,745 patients with COVID-19, of which 161,985 underwent ERCP. The analysis revealed that mortality was increased (OR 1.41, p<0.001, CI: 1.24 - 1.69), LOS was increased (+2.59 days, p<0.0001, CI: 1.17 - 4.01), and TOTHC were increased (+ $56,220.52, p<0.0001, CI: $28,340.61- $84,100.44) for patients undergoing ERCP with COVID 19 compared to patients undergoing ERCP without COVID-19.

The presence of acute kidney injury (AKI) (OR 6.49, p<0.0001, CI: 6.18- 6.81), Stroke (CVA) (OR 1.75, p<0.035, CI: 1.04- 2.94), Non-ST-elevation myocardial infarction (NSTEMI) (OR 2.58, p<0.0001, CI: 2.41- 2.76), coronary artery disease (CAD) (OR 1.47, p<0.001, CI: 1.182 -1.83), and hemodialysis (HD) (OR 4.37, p<0.0001, CI: 4.02- 4.75) worsened mortality in patients with COVID-19 undergoing ERCP.

The presence of AKI (+ 8.56 days, p<0.0001, CI: 8.20- 8.92), venous thrombo-embolism (+8.82 days, p<0.0001, CI: 6.83- 10.82), CVA (+3.92 days, p<0.003, CI:1.35 - 6.48), and HD (+5.72 days, p<0.0001, CI: 5.32 - 6.11) led to an increase in LOS in patients with COVID-19 undergoing ERCP.

The presence of hypertension ($1,577.52, p<0.021, CI: $241.04- $2,914.00), AKI ($187,274.00, p<0.0001, CI: $175,994.50 - $198,553.50), VTE ($103,434.30, p<0.0001, CI: $70,698.35 - $136,170.30), cerebrovascular accident (CVA) ($50,131.06, p<0.034, CI: $3,697.798- $96,564.33), NSTEMI ($ 38,293.22 , p<0.0001, CI: $31,289.62 - $45,296.81), obesity ($11,439.68, p<0.0001, CI: $9,247.63 - $13,631.74) and HD ($135,782.10, p<0.0001, CI: $124,296.70- $147,267.60) led to increased TOTHC in patients with COVID-19 undergoing ERCP.

Conclusion

Compared to patients without COVID-19, concomitant COVID-19 in patients undergoing ERCP led to an increased overall mortality, total hospital charges, and length of stay. We also identified positive predictors of mortality, as well as increased LOS and TOTHC in this patient population.

Introduction

Metabolic dysfunction-associated steatotic liver disease (MASLD) is caused by increased fat accumulation within hepatocytes. It is primarily associated with Type II Diabetes, obesity, and metabolic syndrome. MASLD has become increasingly prevalent worldwide over the past several decades and is regarded as the most common liver disease in industrialized countries. Our study aimed to identify if MASLD would increase mortality amongst patients undergoing ERCP and to identify positive predictors that lead to increased healthcare utilization.

Aims & Methods

A retrospective analysis was completed utilizing the National Inpatient Sample (2015-2020). Patients were identified based on ICD-10 codes corresponding to those with MASLD undergoing ERCP vs. patients without MASLD undergoing ERCP. Primary outcomes were all-cause mortality and healthcare utilization (mean length of stay (LOS) and total hospital charge (TOTCHG). Secondary outcomes such as the effect of the race and post-procedural complications (sepsis, CVA, Bleeding, AKI, post-procedural bleeding) were analyzed using multivariate analysis.

Results

We identified 2,681,575 total patients with MASLD, of whom 1,104,200 underwent ERCP. After propensity score matching, surprisingly, patients with MASLD undergoing ERCP had decreased mortality (OR .45, 95% CI [0.27- 0.75]). However, LOS and TOTHCG were not statistically significant. Multivariate regression revealed the impact of complications on the primary and secondary outcomes
(listed in Tables 1 and 2 https://media-hosting.imagekit.io/6e3b9e79c5d24205/ueg2025.png?Expires=1840250284&Key-Pair-Id=K2ZIVPTIP2VGHC&Signature=VEuGD9QcoSy6tVYrHx0H1kKNixXM~yppVVTHAz0dY8gj52jh3K1Zc4reiU90cbS1J6HGKn4Uc8gjcJ52x4UpG2lib-QVI5UlbXdmI91YjAIVtueBaGfCuMpcpth-hJSWWfl4SInfj8Y-PohyIA0-SfPe7Gk9PRfeUsy5lJzf36dD1xcwzLUCPfsS10zKeyFN4vEJomZyg32NQT7Wx8-P43IQgXvHJz0J5WXXD3IyjpTgfoGxJLVhE5ADXUbXaNWuOeYV5nG2Fb5FvG3HLEzL2q7q0No2xWz3bCmnBC1vsji2zmbkBrRFOEqiaELhCL~Z7Ul86Ns9clhnFGpxyl2Iaw__).
Native Americans were found to have a significant increase in mortality (OR 2.47, 95% CI, p-value <0.05). It was also shown that the presence of post-procedural bleeding, AKI, CVA, and sepsis increased mortality, TOTHC, and LOS in patients with MASLD undergoing ERCP.

Conclusion

Our study identified positive predictors (sepsis, post-procedural bleeding, CVA, or AKI) for increased LOS, Mortality, and TOTHC in patients with MASLD undergoing ERCP. In addition, high rates of obesity, cardiovascular disease, and Type II Diabetes are more prevalent compared to other racial groups in the US. Further studies are needed to identify whether lack of access to healthcare within the country contributes to disease burden and worsened outcomes in this population.

Introduction

Previous case reports and studies have shown frailty to be a risk factor for complications and poor outcomes following surgeries and endoscopic procedures. However, limited studies have examined the impact of frailty on endoscopic retrograde cholangiopancreatography (ERCP). Our study aims to compare patients undergoing ERCP with frailty to those without ERCP to understand the impact of frailty on ERCP better.

Aims & Methods

The NIS is a large, publicly available all-payer inpatient care database in the USA and was queried. We retrospectively analyzed the Nationwide Inpatient Sample (NIS) database for 2015-2019. Patients with a principal diagnosis of ERCP with and without frailty were identified using the ICD-10 codes. Multivariate regression analysis was used to calculate the odds ratios of in-hospital mortality, the average length of hospital stay (LOS), and hospital charges (TOTHC) using STATA 17 MP.

Results

Our study identified approximately 1,088,175 patients undergoing ERCP, of which 1,700 were frail.

On multivariate analysis, in patients undergoing ERCP and frailty as a co-morbidity, positive predictors of increased mortality were the following: sepsis (OR: 9.95, p<0.0001, 95% CI: 2.95 - 16.95), acute kidney injury (AKI) (OR 5.63, p<0.0001, CI 4.64 - 6.82), malnutrition (OR 3.28, p<0.0001, CI 2.66 - 4.04), post-procedural bleeding (OR 2.85, p<0.0069, CI 1.95 - 3.70), aspiration (OR 4.94, p<0.0001, CI 2.59 - 6.80), congestive heart failure (CHF) (OR 1.48, p<0.001, CI 1.19 - 1.86).

LOS was increased if patients had any of the following complications: sepsis (+2.86 days, p<0.0001, 95% CI: 2.59 - 3.13), AKI (+3.44 days, p<0.0001, 95% CI: 3.16 - 3.73), malnutrition (+6.44 days, p<0.0001, CI 5.89 - 6.99), post-procedural bleeding (+4.99 days, p<0.0001, CI 3.29 - 6.68), aspiration (+9.87 days, p<0.0001, 95% CI 7.48 - 12.27), or CHF (+1.87 days, p<0.0001, CI 1.53 - 2.22).

TOTHC were increased in patients who had the following complications: sepsis ($46,978, p<0.0001, CI $41,364 - $52,593), AKI ($53,007, p<0.0001, CI $44,221 - $61,793), malnutrition ($85,454, p<0.0001, $64,515 - $106,393), post-procedural bleeding ($114,168, p<0.0001, $61,465 - $166,871), aspiration ($198,071, p<0.0001, $113,911 - $282,230) or CHF ($20,191, p<0.0001, $12,983 - $27,398).

Conclusion

Based on our study results, those with ERCP who had a co-morbidity of frailty had increased mortality, LOS, and TOTHC with the following complications: sepsis, AKI, malnutrition, post-procedural bleeding, aspiration, and CHF. While frailty is not a contraindication to doing an ERCP, our study demonstrates that there must be close monitoring and preparation of these patients before ERCP to avoid complications because many complications significantly increase mortality. This is a high-risk patient population. Randomized trials will be required to further study the impact of frailty on ERCP.