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Mortality decreased for acute biliary diseases requiring ERCP
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The rate of in-hospital mortality from acute pancreaticobiliary diseases that required endoscopic retrograde cholangiopancreatography decreased in the United States during a 10-year period, according to research data.
Researchers identified 166,438 patients (median age, 60 years; 65% women) hospitalized for choledocholithiasis (CDL), ascending cholangitis (AC) and acute pancreatitis (AP) who required endoscopic retrograde cholangiopancreatography (ERCP) between 1998 and 2008. They analyzed the effects of time period, patient and hospital characteristics, procedural ERCP features and types of cholecystectomies (CLC) on in-hospital mortality, length of stay and costs.
During the study period, 0.8% of patients died in the hospital and the odds of mortality dropped overall from 1.1% to 0.6% (adjusted OR=0.7; 95% CI, 0.6-0.8) as well as for each individual disorder studied (aOR=0.7; 95% CI, 0.6-0.9 for CDL; aOR=0.8; 95% CI, 0.5-1.1 for AC; aOR=0.6; 95% CI, 0.5-0.8 for AP).
Researchers also observed unsuccessful ERCPs decreased from 6.3% to 3.3%, diagnostic ERCPs fell from 28.8% to 10%, hospitals that performed less than 100 ERCPs annually declined from 38.4% to 26.9% and open CLCs decreased from 12.4% to 5.8% (all P<.0001). Unsuccessful ERCP (aOR=1.7; 95% CI, 1.4-2.2), open CLC (aOR=3.4; 95% CI, 2.7-4.3), admission for AC (aOR=1.9; 95% CI, 1.5-2.3), older age, Medicare insurance and comorbidity were linked with increased mortality. In secondary analyses, increased lengths of stay and hospital costs were associated with AC and AP admissions, open CLC, ERCPs performed more than 3 days after admission, and unsuccessful ERCPs.
The researchers said, “We believe that improved in-hospital mortality over time may be attributed to three major developments” — increased laparoscopic CLCs, improved ERCP techniques and early goal-directed resuscitation and timely medical management.
Disclosure: The researchers report no relevant financial disclosures.
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