D0434 - Frailty Scores Do Not Affect ERCP Outcomes for Biliary Stone Disease: A Nationwide Inpatient Assessment

Tuesday, October 25, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Daryl Ramai, MD, MSc

University of Utah
Salt Lake City, UT

Daryl Ramai, MD, MSc¹, Andrew Ofosu, MD, MPH², Joseph Heaton, MD³, Paraskevas Gkolfakis, MD⁴, Saurabh Chandan, MD⁵, Alberto Tringali, MD⁶, Cesare Hassan, MD⁷, Antonio Facciorusso, MD, PhD⁸, Alessandro Repici, MD⁷, Monique Barakat, MD, PhD⁹
¹University of Utah, Salt Lake City, UT; ²University of Cincinnati, Cincinnati, OH; ³The Brooklyn Hospital Center, Brooklyn, NY; ⁴Université libre de bruxelles, Brussels, Brussels Hoofdstedelijk Gewest, Belgium; ⁵CHI Health Creighton School of Medicine, Omaha, NE; ⁶Conegliano Hospital, Conegliano, Veneto, Italy; ⁷IRCCS Humanitas Research Hospital, Milan, Lombardia, Italy; ⁸University of Foggia, Foggia, Puglia, Italy; ⁹Stanford University, Stanford, CA

Introduction: Pancreaticobiliary diseases are common in the elderly. To this end, frailty represents a state of vulnerability which should be considered when assessing the risks and benefits of therapeutic endoscopic procedures. Aim: To determine the rate of readmissions and clinical outcomes using the validated Hospital Frailty Risk Score in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP).

Methods: Using the National Readmissions Database, we identified patients with an admission diagnosis of cholangitis with obstructive stone or cholecystitis with obstructive stone from January-November 2016 to 2019. Patients were determined to be of low frailty risk with a score of < 5, while patients of medium to high frailty risk had a score of >5.

Results: During the study period, 27,365 patients who underwent ERCP were identified. Mean age of index admissions was 59.15 years and 54.75% were female. From the total cohort, 6,572 (24%) of patients underwent therapeutic ERCP on initial admission; of these patients, 31.6% (n=2,064) were regarded as frail (risk score >5). Following ERCP, frail patients did not have a statistically significant readmission rate (8.42% vs. 6.94%, respectively; p= 0.196). The performance of ERCP did not affect readmission rates (OR 1.14, CI: 0.94-1.38, p=0.085). Frail patients were likely to have longer lengths of stay, higher total cost, procedural related complications, and higher risk of morality. Despite this, ERCP was not a significant contributor of mortality risk (HR 0.56, CI 0.31-1.03, p=0.063).

Discussion: ERCP is not a risk factor for readmission among frail patients. However, frail patients are at higher risk for procedure-related complications, healthcare utilization, and mortality.

Figure: Cox regression curve showing the effect of frailty on readmission following ERCP for biliary stone disease.

Variables	Non-frail		Frail		Total		N	P-value
	%	CI	%	CI	%	CI
ERCP
No ERCP	78.84	[77.87-79.78]	66.37	[64.50-68.18]	75.98	[75.04-76.91]	20,793	0.000
ERCP	21.16	[20.22-22.13]	33.63	[31.82-35.50]	24.02	[23.09-24.96]	6,572
Age
< 75 years	82.99	[82.24-83.71]	51.00	[49.12-52.88]	75.66	[74.88-76.42]	20,705	0.000
> 75 years	17.01	[16.29-17.76]	49.00	[47.12-50.88]	24.34	[23.58-25.12]	6,660
Sex
Male	43.92	[42.96-44.90]	49.70	[47.90-51.51]	45.25	[44.39-46.11]	12,382	0.000
Female	56.08	[55.10-57.04]	50.30	[48.49-52.10]	54.75	[53.89-55.61]	14,983
Mortality
Did not die	99.86	[99.74-99.93]	97.71	[97.08-98.21]	99.37	[99.21-99.50]	27,180	0.000
Died	0.14	[0.07-0.26]	2.29	[1.79-2.92]	0.63	[0.50-0.79]	173
Calendar year
2016	26.24	[24.75-27.79]	23.50	[21.72-25.37]	25.61	[24.24-27.03]	7,009	0.001
2017	24.54	[23.24-25.88]	23.06	[21.35-24.88]	24.20	[23.02-25.42]	6,623
2018	24.23	[22.93-25.59]	25.08	[23.36-26.88]	24.43	[23.23-25.66]	6,685
2019	24.99	[23.66-26.37]	28.36	[26.48-30.32]	25.76	[24.51-27.05]	7,049
Insurance
Medicare	37.50	[36.50-38.51]	76.21	[74.52-77.81]	46.45	[45.51-47.40]	12,284	0.000
Medicaid	18.19	[17.32-19.09]	7.95	[7.00-9.01]	15.82	[15.09-16.58]	4,184
Private insurance	37.56	[36.56-38.58]	14.14	[12.90-15.47]	32.14	[31.28-33.02]	8,501
Self-pay	6.75	[6.23-7.30]	1.71	[1.29-2.26]	5.58	[5.16-6.03]	1,476
Median household income
0-25th percentile	26.73	[25.55-27.94]	26.96	[25.23-28.75]	26.78	[25.70-27.89]	7,226	0.425
26th to 50th percentile	27.11	[26.08-28.17]	25.80	[24.09-27.58]	26.81	[25.87-27.78]	7,235
51st to 75th percentile	25.65	[24.67-26.66]	26.88	[25.21-28.62]	25.93	[25.02-26.86]	6,997
76th to 100th percentile	20.50	[19.43-21.61]	20.37	[18.80-22.03]	20.47	[19.47-21.51]	5,524
Hospital bed size
Small	18.80	[17.68-19.97]	18.31	[16.73-20.01]	18.69	[17.64-19.78]	5,114	0.018
Medium	30.53	[29.14-31.97]	28.07	[26.23-29.98]	29.97	[28.69-31.28]	8,201
Large	50.67	[49.07-52.26]	53.62	[51.52-55.71]	51.34	[49.88-52.81]	14,050
Hospital urban-rural designation
Metropolitan areas with at least 1 million residents	58.39	[56.71-60.04]	57.77	[55.52-59.99]	58.24	[56.67-59.81]	15,939	0.000
Metropolitan areas with less than 1 million residents	33.77	[32.20-35.37]	36.53	[34.36-38.75]	34.40	[32.91-35.93]	9,414
Micropolitan areas	6.01	[5.33-6.77]	4.68	[3.90-5.60]	5.70	[5.11-6.36]	1,561
Not metropolitan or micropolitan (non-urban residual)	1.84	[1.49-2.27]	1.02	[0.68-1.53]	1.65	[1.35-2.01]	452
Hospital teaching status
Metropolitan non-teaching	26.85	[25.56-28.17]	24.29	[22.63-26.04]	26.26	[25.08-27.48]	7,187	0.000
Metropolitan teaching	65.31	[63.85-66.74]	70.00	[68.12-71.82]	66.38	[65.06-67.69]	18,166
Non-metropolitan hospital	7.84	[7.07-8.69]	5.70	[4.84-6.71]	7.35	[6.69-8.08]	2,013
Patient Location: Urban-Rural Code
Central metro areas of >=1 million population	29.86	[28.20-31.59]	26.11	[24.21-28.10]	29.01	[27.47-30.59]	7,915	0.007
Fringe metro areas of >=1 million population	26.34	[24.90-27.85]	28.01	[25.99-30.11]	26.73	[25.34-28.16]	7,292
Metro areas of 250,000-999,999 population	20.92	[19.64-22.27]	21.46	[19.72-23.31]	21.05	[19.83-22.32]	5,742
Metro areas of 50,000-249,999 population	8.72	[7.91-9.61]	9.46	[8.34-10.71]	8.89	[8.13-9.71]	2,426
Micropolitan counties	8.21	[7.48-9.00]	8.19	[7.08-9.47]	8.21	[7.53-8.93]	2,239
Not metropolitan or micropolitan counties	5.94	[5.35-6.59]	6.77	[5.82-7.86]	6.13	[5.58-6.73]	1,672
Day of Admission
Admitted Monday-Friday	72.95	[72.12-73.78]	74.52	[72.86-76.12]	73.31	[72.58-74.04]	20,063	0.100
Admitted Saturday-Sunday	27.05	[26.22-27.88]	25.48	[23.88-27.14]	26.69	[25.96-27.42]	7,303	0.100

Table: Study baseline characteristics of patients admitted with a primary diagnosis of acute cholecystitis with obstructing stone or acute cholangitis with obstructing stone

Disclosures:

Daryl Ramai indicated no relevant financial relationships.

Andrew Ofosu indicated no relevant financial relationships.

Joseph Heaton indicated no relevant financial relationships.

Paraskevas Gkolfakis indicated no relevant financial relationships.

Saurabh Chandan indicated no relevant financial relationships.

Alberto Tringali indicated no relevant financial relationships.

Cesare Hassan indicated no relevant financial relationships.

Antonio Facciorusso indicated no relevant financial relationships.

Alessandro Repici indicated no relevant financial relationships.

Monique Barakat indicated no relevant financial relationships.

Daryl Ramai, MD, MSc¹, Andrew Ofosu, MD, MPH², Joseph Heaton, MD³, Paraskevas Gkolfakis, MD⁴, Saurabh Chandan, MD⁵, Alberto Tringali, MD⁶, Cesare Hassan, MD⁷, Antonio Facciorusso, MD, PhD⁸, Alessandro Repici, MD⁷, Monique Barakat, MD, PhD⁹. D0434 - Frailty Scores Do Not Affect ERCP Outcomes for Biliary Stone Disease: A Nationwide Inpatient Assessment, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.