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.
