Abstract
Background
Endoscopic retrograde cholangiopancreatography (ERCP) is a diagnostic/therapeutic endoscopic procedure for numerous pancreaticobiliary diseases. Data regarding performing ERCP on weekend (WE; Saturday/Sunday) versus postponing ERCP to first two available weekdays (WD; Monday/Tuesday) are scarce. ERCP requires costly resources including specialized nurses, endoscopy room equipped with fluoroscopy, anesthesia services, and highly trained therapeutic endoscopists. Hospitals frequently do not have these resources readily available during WE, leading to postponing ERCPs to WD.
Aims
This study analyzes the effect of performing ERCP on WE versus postponement to WD on hospital efficiency, and on patient safety/outcomes.
Methods
A computerized search of electronic medical records, January 2011–December 2016, at four Beaumont Hospitals retrospectively identified all gastroenterology consults performed on Friday or Saturday before 12:00 noon, which resulted in ERCP performed for any indication on WE versus postponing ERCP to WD. Length of stay (LOS), hospital costs, hospital charges, and hospital reimbursements were compared between both groups, as were quality of care measures.
Results
Among 5196 patients undergoing ERCPs, 533 patients were identified, including 315 patients in the WE group and 218 patients in the WD group. Comparing WE versus WD groups, median LOS was shorter (4.5 days vs. 6.9 days, p < 0.0001); median hospital costs were less ($9208 vs. $11,657, p < 0.0001); and median hospital charges were less ($28,026 vs. $37,899, p < 0.0001). Median hospital reimbursements were not significantly different in WE versus WD groups ($10,277 vs. $10,362, p = 0.65). Median hospital charges were lower than median hospital reimbursements (net profit) in WE but not in WD. WE versus WD had no significant differences in morbidity, mortality, ≤ 30-day readmission rates, need for repeat ERCP ≤ 30 days, or post-ERCP complications.
Limitations
This is a retrospective study.
Conclusions
Performing ERCPs during weekends significantly reduced LOS, hospital costs, and hospital charges compared to postponing ERCP to WD and resulted in net hospital profits, without impairing quality of medical care.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Mazen jamal M, Yoon EJ, Saadi A, Sy TY, Hashemzadeh M. Trends in the utilization of endoscopic retrograde cholangiopancreatography (ERCP) in the United States. Am J Gastroenterol. 2007;102:966–975. https://doi.org/10.1111/j.1572-0241.2007.01127.x.
Inamdar S, Sejpal DV, Ullah M, Trindade AJ. Weekend vs. weekday admissions for cholangitis requiring an ERCP: comparison of outcomes in a National Cohort. Am J Gastroenterol. 2016;111:405–410. https://doi.org/10.1038/ajg.2015.425.
Parikh ND, Issaka R, Lapin B, Komanduri S, Martin JA, Keswani RN. Inpatient weekend ERCP is associated with a reduction in patient length of stay. Am J Gastroenterol. 2014;109:465–470. https://doi.org/10.1038/ajg.2013.362.
Sood N, Huckfeldt PJ, Escarce JJ, Grabowski DC, Newhouse JP. Medicare’s bundled payment pilot for acute and postacute care: analysis and recommendations on where to begin. Health Aff (Millwood). 2011;30:1708–1717. https://doi.org/10.1377/hlthaff.2010.0394.
Peery AF, Crockett SD, Murphy CC, et al. Burden and cost of gastrointestinal, liver, and pancreatic diseases in the United States: update 2018. Gastroenterology. 2019;156:254–272.e11. https://doi.org/10.1053/j.gastro.2018.08.063.
Tanno N, Koizumi M, Goto Y. The relationship between cholelithiasis and diabetes mellitus: discussion of age, obesity, hyperlipidemia and neuropathy. Tohoku J Exp Med. 1988;154:11–20. https://doi.org/10.1620/tjem.154.11.
Parikh MP, Gupta NM, Thota PN, Lopez R, Sanaka MR. Temporal trends in utilization and outcomes of endoscopic retrograde cholangiopancreatography in acute cholangitis due to choledocholithiasis from 1998 to 2012. Surg Endosc. 2018;32:1740–1748. https://doi.org/10.1007/s00464-017-5856-7.
Jamal MM, Yamini D, Singson Z, Samarasena J, Hashemzadeh M, Vega KJ. Decreasing hospitalization and in-hospital mortality related to cholangitis in the United States. J Clin Gastroenterol. 2011;45:e92–e96. https://doi.org/10.1097/MCG.0b013e31822f364c.
Ahmed M, Kanotra R, Savani GT, et al. Utilization trends in inpatient endoscopic retrograde cholangiopancreatography (ERCP): a cross-sectional US experience. Endosc Int Open. 2017;5:E261–E271. https://doi.org/10.1055/s-0043-102402.
Long KH, Moriarty JP, Ransom JE, et al. Economic and clinical impact of routine weekend catheterization services. Am J Manag Care. 2016;22:e233–e240.
Kostis WJ, Demissie K, Marcella SW, et al. Weekend versus weekday admission and mortality from myocardial infarction. N Engl J Med. 2007;356:1099–1109. https://doi.org/10.1056/NEJMoa063355.
Shaheen AA, Kaplan GG, Myers RP. Weekend versus weekday admission and mortality from gastrointestinal hemorrhage caused by peptic ulcer disease. Clin Gastroenterol Hepatol. 2009;7:303–310. https://doi.org/10.1016/j.cgh.2008.08.033.
Ananthakrishnan AN, Mcginley EL. Weekend hospitalisations and post-operative complications following urgent surgery for ulcerative colitis and Crohn’s disease. Aliment Pharmacol Ther. 2013;37:895–904. https://doi.org/10.1111/apt.12272.
Tabibian JH, Yang JD, Baron TH, Kane SV, Enders FB, Gostout CJ. Weekend admission for acute cholangitis does not adversely impact clinical or endoscopic outcomes. Dig Dis Sci. 2016;61:53–61. https://doi.org/10.1007/s10620-015-3853-z.
Author information
Authors and Affiliations
Contributions
Drs. Hakim, Aneese, and Cappell are equal primary authors. They wrote the first compete draft and completed most of the revisions. Drs. Cannon and Cappell served as mentors for this study. Dr. Purohit initiated the concept and study protocol. Drs. Edhi and Shams contributed importantly to data collection and wrote a partial draft of the results.
Corresponding author
Ethics declarations
Conflict of interest
None for all authors. None of the authors received any financial support for writing this article. In particular, Dr. Cappell, as a consultant of the United States Food and Drug Administration (FDA) Advisory Committee for Gastrointestinal Drugs, affirms that this paper does not discuss any proprietary, confidential, pharmaceutical data submitted to the FDA. Dr. Cappell was also a member of the speaker’s bureau for AstraZeneca and Daiichi Sankyo, co-marketers of Movantik until more than 1 year ago. Dr. Cappell received a one-time honorarium from Shire and Mallinckrodt more than 1 year ago. This work does not discuss any drug manufactured or marketed by AstraZeneca, Daiichi Sankyo, Shire, or Mallinckrodt.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Institutional Review Board (IRB approval): Obtained February 8, 2016, from Beaumont Health System Research Institute Institutional Review Board (IRB number 2015-457). See separately submitted form.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Hakim, S., Aneese, A.M., Edhi, A. et al. A Statistically Significant Reduction in Length of Stay and Hospital Costs with Equivalent Quality of Care Metrics for ERCPs Performed During the Weekend Versus Postponed to Weekdays: A 6-Year Study of 533 ERCPs at Four Teaching Hospitals. Dig Dis Sci 65, 3132–3142 (2020). https://doi.org/10.1007/s10620-020-06066-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10620-020-06066-z