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Predictors of 30-Day Readmission After Inpatient Endoscopic Retrograde Cholangiopancreatography: A Single-Center Experience

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Abstract

Introduction

The 30-day hospital readmission rate is a nationally recognized quality measure. Nearly one-fifth of medicare beneficiaries are hospitalized within 30 days of discharge, resulting in a cost of over $26 billion dollars annually. Endoscopic retrograde cholangiopancreatography (ERCP) remains the endoscopic procedure with the highest risk of morbidity and mortality. We set out to analyze the clinical characteristics predictive of 30-day readmission after an inpatient ERCP.

Methods

We performed a retrospective chart review of all inpatient ERCPs performed at our institution between 12/1/2014 and 9/30/2018. Clinical characteristics and outcomes of these patients were compared to determine predictors of 30-day readmission.

Results

A total of 497 inpatient ERCP procedures done for biliary or pancreatic indications, constituting 483 patients, were identified. There were 52 readmissions that occurred among 48 patients within 30 days of discharge. Basic demographic characteristics were similar between both groups. Comorbidities were significantly higher in those who were readmitted. Multivariate analysis revealed significantly greater odds of readmission with prior liver transplantation (OR = 4.15), cirrhosis (OR = 3.20), and pancreatic duct stent placement (OR = 2.56). Subgroup analysis for biliary indications revealed cholecystectomy before discharge and early ERCP to be protective against readmission.

Conclusion

A history of liver transplantation and cirrhosis are predictive of increased 30-day readmission rates after an inpatient ERCP. Pancreatic duct stent placement is associated with readmission; however, this phenomenon is likely related to stenting for pancreatic endotherapy. Cholecystectomy before discharge and early ERCP are predictive of decreased need for readmission in procedures done for biliary indications.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555-0570, USA

    Timothy S. Krill, Praveen Guturu & Sreeram Parupudi

  2. Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA

    Rebecca Crain, Yamam Al-Saadi, Samantha Stubbs, Russell Roark, Ahmed Chatila, Christina Haddad, Chandni Kaushik & Felippe Marcondes

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  1. Timothy S. Krill
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  2. Rebecca Crain
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  3. Yamam Al-Saadi
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  4. Samantha Stubbs
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  5. Russell Roark
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  6. Ahmed Chatila
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  7. Christina Haddad
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  8. Chandni Kaushik
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  10. Praveen Guturu
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Correspondence to Timothy S. Krill.

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Krill, T.S., Crain, R., Al-Saadi, Y. et al. Predictors of 30-Day Readmission After Inpatient Endoscopic Retrograde Cholangiopancreatography: A Single-Center Experience. Dig Dis Sci 65, 1481–1488 (2020). https://doi.org/10.1007/s10620-019-05870-6

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  • DOI: https://doi.org/10.1007/s10620-019-05870-6

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