A0420 - Looking at the “Holiday Effect” on Post-ERCP Complications: A National Inpatient Sample Database Study

Sunday, October 23, 2022

5:00 PM – 7:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

Vincent Wong, MD

Rutgers New Jersey Medical School
Newark, NJ

Vincent Wong, MD, Anjella Manoharan, MS, MD, Faiz Afridi, MD, Sushil Ahlawat, MD
Rutgers New Jersey Medical School, Newark, NJ

Introduction: The “weekend effect” and “July effect” were studies that looked at the outcome of endoscopic retrograde cholangiopancreatography (ERCP) procedures in relation to a specific time. Admissions on the weekends have been shown to lead to delays in patients with gallstone pancreatitis, while patients admitted in July had higher rates of post-procedural sepsis. Here, we evaluate the effects of the “holiday effect” during the month of December on post-ERCP complication rates.

Methods: The National Inpatient Sample database was used to identify hospitalized patients over 18 years old who had an ERCP procedure between 2007 - 2017 using ICD9 and ICD10 codes. Patients were divided into two groups: those who were admitted in December and those who were admitted in other months. Primary outcome was overall mortality. Secondary outcomes were post-ERCP pancreatitis, cholangitis, cholecystitis, infection, hemorrhage, perforation. Patients were matched by age, race, gender, and by the Elixhauser comorbidity index. Multivariate analyses were performed to assess outcomes and independent t-tests were used to compare mortality trends by year.

Results: Of the 294,853 patients who had an ERCP between 2007 and 2017, 142,206 patients were admitted in December for the procedure. There was an increase in overall mortality (OR 1.1, p=0.002) for patients who had an ERCP done during December compared to other months. The annual trends comparing mortality rates of patients after ERCP complications were significant (p< 0.001). The data was significant for post-ERCP cholecystitis in December (OR 1.8, p< 0.001) but not for post-ERCP pancreatitis, cholangitis, infection, hemorrhage, and perforation.

Discussion: December is one of the busiest months due to the holidays. During this time, hospitals may be inadequately staffed and employees may have irregular hours or additional stressors, leading to a higher overall post-ERCP mortality rate. Patients may also choose not to have procedures done during this time, coming in only for emergent and urgent issues requiring ERCP. Looking at the trends from 2007 to 2017, there was an overall decrease in post-ERCP mortality, which can be attributed to improvement in endoscopic techniques and staff holiday schedules. Patients also had an increase in post-ERCP cholecystitis, which may be influenced by poor dietary choices. Endoscopists should be aware of this “holiday effect” when performing ERCPs in December.

	P-Value	Odds Ratio (95% CI)
Post-ERCP Pancreatitis	0.060	1.1 (1.0-1.3)
Post-ERCP Cholangitis	0.335	0.9 (0.8-1.1)
Post-ERCP Cholecystitis	< 0.001	1.8 (1.3-2.6)
Post-ERCP Infection	0.315	1.1 (0.9-1.2)
Post-ERCP Hemorrhage	0.083	1.3 (1.0-1.7)
Post-ERCP Perforation	0.745	1.0 (0.8-1.3)
Overall Mortality	0.002	1.1 (1.0-1.2)

Table: Clinical Outcomes of the "Holiday Effect" After Endoscopic Retrograde Cholangiopancreatography (ERCP). CI = Confidence Interval

Disclosures:

Vincent Wong indicated no relevant financial relationships.

Anjella Manoharan indicated no relevant financial relationships.

Faiz Afridi indicated no relevant financial relationships.

Sushil Ahlawat indicated no relevant financial relationships.

Vincent Wong, MD, Anjella Manoharan, MS, MD, Faiz Afridi, MD, Sushil Ahlawat, MD. A0420 - Looking at the “Holiday Effect” on Post-ERCP Complications: A National Inpatient Sample Database Study, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.