One Brooklyn Health System, Brookdale University Hospital and Medical Center Brooklyn, NY, United States
Sharanya Reddy Nemakallu, MD1, Ese Uwagbale, MD2, Junxin Shi, MD, PhD3, Tamta Chkhikvadze, MD4 1One Brooklyn Health System, Brookdale University Hospital and Medical Center, Brooklyn, NY; 2Brookdale University Hospital Medical Center, Brooklyn, NY; 3The Research Institute at Nationwide Children's Hospital, Columbus, OH; 4NYU Grossman School of Medicine; One Brooklyn Health System Brookdale University Hospital and Medical Center, New York, NY
Introduction: Early Endoscopic retrograde cholangiopancreatography (ERCP) performance improves outcomes in acute cholangitis; however, controversy regarding the optimal timing of the procedure persists. We aimed to analyze the timing of ERCP to detect practice patterns and trends in the United States.
Methods: In our retrospective, cross-sectional analysis using the Nationwide Inpatient Sample (NIS) from 2005 to 2014, we extracted hospitalization data of patients >13 years old from 2005 to 2014 with primary and secondary ICD-9 diagnosis for cholangitis and choledocholithiasis (576.1, 574.5) and associated non-elective ERCP procedure codes. ERCP timing was divided into urgent (< 24hours), early (24-48 hours), and delayed ( >48hours) groups. Temporal trends were analyzed across the years, as well as sociodemographic and economic data. Inpatient mortality, hospitalization charges, and length of stay (LOS) were used as outcomes and analyzed for separate groups by the timing of ERCP.
Results: We identified 498,129 hospitalizations for cholangitis and choledocholithiasis who underwent ERCP. The number of yearly procedures increased throughout the analyzed years from 40,699 in 2005 to 58,050 in 2014. Forty-seven percent of patients were above age 70; female to male predominance was noted. Most patients were white, followed by Hispanic and Black. ERCP performance increased in the publicly insured and the least wealthy (64.8% to 70%). In addition, ERCP has risen significantly in teaching hospitals (46.9% to 72.6%). Performance of urgent ERCP has remained relatively unchanged with a minor increase from 20.4% to 21.1%. A significant increase was noted in the proportion of ERCP performed in 24- 48hrs (from 49.7% in 2005 to 55% in 2014), with a proportionate decrease in delayed ERCP (Table 1). Mean charges and LOS have increased for hospitalizations with urgent and decreased in early ERCP groups. For all ERCP procedures, in-hospital mortality decreased from 2 to 1.6% throughout the respective years. Mortality was comparable between urgent (1.46%) and early (1.5%) ERCP groups but higher in the delayed group (2.88%).
Discussion: A significant increase has been noted in the performance of early ERCP for acute cholangitis and choledocholithiasis. 24-48 hours from admission is the optimal timing regarding hospital resource utilization and outcomes. Favorable trends of improved outcomes, increased prompt procedure timing and decreased mortality has been noted in this disease management.
Figure: Figure 1: Trends of timing of ERCP in acute cholangitis, NIS 2005-2014
Sharanya Reddy Nemakallu indicated no relevant financial relationships.
Ese Uwagbale indicated no relevant financial relationships.
Junxin Shi indicated no relevant financial relationships.
Tamta Chkhikvadze indicated no relevant financial relationships.
Sharanya Reddy Nemakallu, MD1, Ese Uwagbale, MD2, Junxin Shi, MD, PhD3, Tamta Chkhikvadze, MD4. P2105 - Timing of ERCP in Cholangitis; Associated Trends and Outcomes, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.