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.