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Surgical Endoscopy

, Volume 33, Issue 1, pp 169–178 | Cite as

National trends of endoscopic retrograde cholangiopancreatography utilization and outcomes in decompensated cirrhosis

  • Dhruv MehtaEmail author
  • Priti Poojary
  • Aparna Saha
  • Supreet Kaur
  • Shanti Patel
  • Lavneet Chawla
  • Arun Kumar
  • Priya Simoes
  • Deepthi Busayavalasa
  • Girish Nadkarni
  • Madhusudhan Sanaka
Article
  • 137 Downloads

Abstract

Background

Endoscopic retrograde cholangiopancreatography (ERCP) can be challenging in patients with decompensated cirrhosis (DC) due to increased risk of adverse events related to liver dysfunction. Limited data exist regarding its national utilization in patients with DC. We aim to determine the trends in utilization and outcomes of ERCP among patients with DC in US hospitalizations.

Methods

We identified hospitalizations undergoing ERCP (diagnostic and therapeutic) between 2000 and 2013 from the National Inpatient Sample (NIS) database and used validated ICD9-CM codes to identify DC hospitalizations. We utilized Cochrane–Armitage test to identify changes in trends and multivariable survey regression modeling for adjusted odds ratios (aOR) for adverse outcomes and mortality predictors.

Results

There were 43782 cases of ERCPs performed in DC patients during the study period. Absolute number of ERCPs performed in this population from 2000 to 2013 showed an upward trend; however, the proportion of DC patients undergoing ERCP remained stable. We noted significant decrease in utilization of diagnostic ERCP and an increase of therapeutic ERCPs (P < 0.01). There was a significant decrease in the mean length of stay for DC patients undergoing ERCP from 8.2 days in 2000 to 7.2 days in 2013 (P < 0.01) with an increase in the mean cost of hospitalization from $17053 to $19825 (P < 0.001). Mortality rates showed a downward trend from 2000 to 2013 from 13.6 to 9.6% (P < 0.01). Increasing age, Hispanic race, diagnosis of hypertension and diabetes mellitus, and private insurance were related to adverse discharges(P < 0.01). Increasing age, presence of hepatic encephalopathy, and sepsis were associated with higher mortality (P < 0.01).

Conclusions

There is an increasing trend in therapeutic ERCP utilization in DC hospitalizations nationally. There is an overall decrease in mortality in DC hospitalizations undergoing ERCP. This improvement in mortality suggests improvement in both procedural technique and peri-procedural care as well as overall decreasing mortality in cirrhosis.

Keywords

ERCP Cirrhosis Epidemiology Trends Healthcare utilization 

Notes

Compliance with ethical standards

Disclosures

Drs. Dhruv Mehta, Priti Poojari, Aparna Saha, Supreet Kaur, Shanti Patel, Lavneet Chawla, Arun Kumar, Priya Simoes, Deepthi Busayavalasa, Girish Nadkarni, and Madhusudhan Sanaka have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Dhruv Mehta
    • 1
    Email author
  • Priti Poojary
    • 2
  • Aparna Saha
    • 2
  • Supreet Kaur
    • 3
  • Shanti Patel
    • 4
  • Lavneet Chawla
    • 5
  • Arun Kumar
    • 5
  • Priya Simoes
    • 6
  • Deepthi Busayavalasa
    • 7
  • Girish Nadkarni
    • 2
  • Madhusudhan Sanaka
    • 8
  1. 1.Department of Gastroenterology and Hepatolobiliary DiseaseWestchester Medical Center at New York Medical CollegeValhallaUSA
  2. 2.Division of Nephrology, Department of MedicineIcahn School of Medicine at Mount SinaiNew YorkUSA
  3. 3.Department of Hematology and OncologySt. Joseph’s Regional Medical CenterPatersonUSA
  4. 4.Department of Internal MedicineMaimonides Medical CenterBrooklynUSA
  5. 5.Department of Internal MedicineWestchester Medical Center at New York Medical CollegeValhallaUSA
  6. 6.Division of Gastroenterology, Hepatology and NutritionMemorial Sloan Kettering Cancer CenterNew YorkUSA
  7. 7.Department of Internal MedicineAdvocate Christ Medical Center Oak LawnOak LawnUSA
  8. 8.Division of Gastroenterology and Hepatobiliary DiseasesCleveland ClinicClevelandUSA

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