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Influence of Frailty in Patients Undergoing Endoscopic Retrograde Cholangiopancreatography for Biliary Stone Disease: A Nationwide Study

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Abstract

Background and Aims

Pancreaticobiliary diseases are common in the elderly. To this end, frailty represents a state of vulnerability that should be considered when assessing the risks and benefits of therapeutic endoscopic procedures. We aim to determine the rate of readmissions and clinical outcomes using the validated Hospital Frailty Risk Score in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP).

Methods

Using the National Readmissions Database, we identified patients with an admission diagnosis of cholangitis with obstructive stone from 2016 to 2019. Patients were determined to be of low frailty risk with a score of < 5, while patients of medium to high frailty risk had a score of > 5.

Results

During the study period, 5751 patients were identified with acute cholangitis with obstructing stone. Mean age of index admissions was 69.4 years and 51.8% were female. From the total cohort, 5119 (89.2%) patients underwent therapeutic ERCP, 38.0% (n = 1947) of whom were regarded as frail (risk score > 5). Following ERCP, frail patients had a less but statistically insignificant readmission rate compared to non-frail patients (2.76% vs 4.05%, p = 0.450). However, compared to non-frail patients, frail patients experienced higher post-ERCP complications (6.20% vs 14.63%, p < 0.001). Frail patients were more likely to have longer lengths of stay, higher hospital cost, and mortality risk.

Conclusion

ERCP is not a risk factor for readmission among frail patients. However, frail patients are at higher risk for procedure-related complications, healthcare utilization, and mortality.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, UT, USA

    Daryl Ramai

  2. Department of Medicine, Jersey Shore University Medical Center, Neptune City, NJ, USA

    Joseph Heaton

  3. Division of Digestive Diseases, University of Cincinnati, Cincinnati, OH, USA

    Andrew Ofosu

  4. Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium

    Paraskevas Gkolfakis

  5. Division of Gastroenterology & Hepatology, CHI Health Creighton University Medical Center, Omaha, NE, USA

    Saurabh Chandan

  6. Endoscopy Unit, Conegliano Hospital Italy, Conegliano, Italy

    Alberto Tringali

  7. Division of Gastroenterology, Stanford University, Stanford, CA, USA

    Monique T. Barakat

  8. Endoscopic Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Milan, Italy

    Cesare Hassan & Alessandro Repici

  9. Department of Biomedical Sciences, Humanitas University, Milan, Italy

    Cesare Hassan & Alessandro Repici

  10. Section of Gastroenterology, Department of Medical Sciences, University of Foggia, 71122, Foggia, Italy

    Antonio Facciorusso

Authors
  1. Daryl Ramai
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  2. Joseph Heaton
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Contributions

DR conceived and designed the study. AO, PG, and SC collected data. DR and JH conducted data analysis. DR drafted the manuscript. AT, MTB, CH, AR, and AF revised the manuscript for intellectual content. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Daryl Ramai.

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Conflict of interest

Alessandro Repici is a consultant for Boston Scientific and Fuji. Daryl Ramai, Joseph Heaton, Andrew Ofosu, Paraskevas Gkolfakis, Saurabh Chandan, Alberto Tringali, Monique T. Barakat, Cesare Hassan, and Antonio Facciorusso have no conflicts of interest or financial ties to disclose.

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Ramai, D., Heaton, J., Ofosu, A. et al. Influence of Frailty in Patients Undergoing Endoscopic Retrograde Cholangiopancreatography for Biliary Stone Disease: A Nationwide Study. Dig Dis Sci 68, 3605–3613 (2023). https://doi.org/10.1007/s10620-023-08013-0

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  • DOI: https://doi.org/10.1007/s10620-023-08013-0

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