Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) has evolved as a valuable tool in therapeutic management of pancreatobiliary disorders but is associated with a range of significant complications, the most common being post-ERCP pancreatitis (PEP). The aim of this study was to elucidate the impact of opiate use on the development and severity of post-endoscopic retrograde cholangiopancreatography. Pancreatitis (PEP).
Methods: We retrospectively analyzed patients who were hospitalized in 2017 using the national inpatient sample (NIS) database who underwent endoscopic retrograde cholangiopancreatography (ERCP) (via ICD-10 procedure codes). Our study group consisted of patients who had a secondary diagnosis of opiate use, and our control group consisted of patients who did not have a secondary diagnosis of opiate use. Our primary end point was to elucidate if the presence of opiate use increased the risk of developing post-ercp pancreatitis. Additionally, we assessed if opiate use worsened outcomes in patients who underwent ERCP. We accomplished this by extracting variables such as length of hospital stay (LOS), total hospital charges and in hospital mortality rates. Categorical variables were compared using the chi-square test, and continuous variables were compared using t-test. Multivariate regressions models and all statistical analysis were performed using STATA 16 software.
Results: A total of 172,255 patients who underwent ERCP were identified, of which 2,120 were opiate users. Opiate users were hospitalized at a younger age when compared to opiate non-users (53.7 years vs 60.5 years; p-value: < 0.01), had a longer length of hospital stay (8.3 days vs 6.0 days; p-value: < 0.01), total hospital charges ($102,469 vs $82,191; p-value: < 0.01) and higher incidence of PEP (4% vs 2.7%; p-value: < 0.01).
Discussion: Opiate use is associated with younger age of presentation, increased LOS, total hospital charges, and increased frequency of PEP amongst patients undergoing ERCP. Further investigation is needed to assess the extent to which chronic opiate use may be a risk factor for post-ERCP pancreatitis and worse outcomes. If so, discontinuation of opiates before ERCP may be reasonable when possible.
