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Racial disparities in endoscopic retrograde cholangiopancreatography (ERCP) utilization in the United States: are we getting better?

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Abstract

Background

We identified trends of inpatient therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in the United States (US), focusing on outcomes related to specific patient demographics.

Methods

The National Inpatient Sample was utilized to identify all adult inpatient ERCP in the US between 2007–2018. Trends of utilization and adverse outcomes were highlighted. P-values ≤ 0.05 were considered statistically significant.

Results

We noted a rising trend for total inpatient ERCP in the US from 126,921 in 2007 to 165,555 in 2018 (p = 0.0004), with a significant increase in utilization for Blacks, Hispanics, and Asians. Despite an increasing comorbidity burden [Charlson Comorbidity Index (CCI) score ≥ 2], the overall inpatient mortality declined from 1.56% [2007] to 1.46% [2018] without a statistically significant trend (p = 0.14). Moreover, there was a rising trend of inpatient mortality for Black and Hispanic populations, while a decline was noted for Asians. After a comparative analysis, we noted higher rates of inpatient mortality for Blacks (2.4% vs 1.82%, p = 0.0112) and Hispanics (1.17% vs 0.83%, p = 0.0052) at urban teaching hospitals between July toand September compared to the October to June study period; however, we did not find a statistically significant difference for the Asian cohort (1.9% vs 2.10%, p = 0.56). The mean length of stay (LOS) decreased from 7 days in 2007 to 6 days in 2018 (p < 0.0001), while the mean total hospital charge (THC) increased from $48,883 in 2007 to $85,909 in 2018 (p < 0.0001) for inpatient ERCPs. Compared to the 2015–2018 study period, we noted higher rates of post-ERCP pancreatitis (27.76% vs 17.25%, p < 0.0001) from 2007–2014.

Conclusion

Therapeutic ERCP utilization and inpatient mortality were on the rise for a subset of the American minority population, including Black and Hispanics.

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Data availability

The NIS is a large, publicly available database accessed at https://www.hcup-us.ahrq.gov. Due to the large sample size provided by the NIS, it is ideal for estimating national trends and outcomes.

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Acknowledgements

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Funding

No funding was received for this study, and the authors have no financial disclosures.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI, USA

    Dushyant Singh Dahiya

  2. Parkview Cancer Institute, Fort Wayne, IN, USA

    Abhilash Perisetti

  3. Division of Interventional Oncology & Surgical Endoscopy (IOSE), Parkview Cancer Institute, Fort Wayne, IN, USA

    Neil Sharma

  4. Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA

    Neil Sharma

  5. Department of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Sumant Inamdar

  6. The Wright Center for Graduate Medical Education, Scranton, PA, USA

    Hemant Goyal

  7. Department of Internal Medicine, Mercer University School of Medicine, Macon, GA, USA

    Hemant Goyal

  8. Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, Cleveland, OH, USA

    Amandeep Singh, Rajat Garg & Madhusudhan Sanaka

  9. Section of Digestive Diseases, Yale New Haven Hospital, New Haven, CT, USA

    Laura Rotundo

  10. Department of Statistics, Actuarial and Data Science, Central Michigan University, Mt Pleasant, MI, USA

    Chin-I Cheng

  11. Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, AZ, USA

    Sailaja Pisipati

  12. Division Chief and Professor of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA

    Mohammad Al-Haddad

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  1. Dushyant Singh Dahiya
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Corresponding author

Correspondence to Dushyant Singh Dahiya.

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Disclosures

Dushyant Singh Dahiya, Abhilash Perisetti, Neil Sharma, Sumant Inamdar, Hemant Goyal, Amandeep Singh, Laura Rotundo, Rajat Garg, Chin-I Cheng, Sailaja Pisipati, Mohammad Al-Haddad, and Madhusudhan Sanaka have no conflict or financial interest to declare.

Ethical approval

The NIS database does not contain any information which can be used to identify patient identity. Hence, our study was exempt from Institutional Review Board (IRB) approval per our institutional guidelines.

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Dahiya, D.S., Perisetti, A., Sharma, N. et al. Racial disparities in endoscopic retrograde cholangiopancreatography (ERCP) utilization in the United States: are we getting better?. Surg Endosc 37, 421–433 (2023). https://doi.org/10.1007/s00464-022-09535-w

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