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Procedure Volume Predictive of Adverse Events Following ERCP
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The volume of endoscopic retrograde cholangiopancreatography procedures done at a health care facility was a strong predictor of risk for unplanned hospital encounters following a procedure, according to research published in Gastroenterology.
Subhas Banerjee, MD, of the division of gastroenterology and hepatology at Stanford University, and colleagues wrote that finding accurate data on the performance of ERCP can be difficult because of the diverse health care landscape in the United States.
“The quoted rates of adverse events following ERCP are derived mainly from academic centers and reflect the outcomes of high-volume academic endoscopists practicing in well-equipped endoscopy units, supported by experienced nurses and technicians,” they wrote. “As the vast majority of patients in the U.S. do not receive care at academic centers, these data may not accurately reflect the risk patients face when undergoing ERCP in community settings.”
Banerjee and colleagues analyzed data from 68,642 ERCPs performed at 635 facilities in California, Florida and New York between 2009 and 2014 to find patient and facility factors associated with unplanned hospital encounters (UHE).
The median number of ERCPs performed was 68.7 per year, with facilities in the 25th percentile performing 32.3 and facilities in the 75th percentile performing 129. Additionally, researchers found that 69% of facilities performed 100 or fewer ERCPs per year.
Investigators found that the 7-day rate of UHE was 5.8%, and the 30-day rate was 10.2%.
In assessing for patient-related risk factors, Banerjee and colleagues found older age was inversely associated with UHE (OR = 0.89; 95% CI, 0.87–0.91), while female sex was associated with UHE (OR = 1.16; 95% CI, 1.16–1.32). Additionally, they found that overall comorbidity, serious cardiac disease, pulmonary disease, diagnosis of malignancy and vascular disease were all associated with UHE.
Banerjee and colleagues found that increasing facility volume and ability to perform endoscopic ultrasound was inversely associated with risk for UHE. Facilities that performed more than 300 procedures per year demonstrated a 25% reduction in odds of an adverse event compared with facilities that performed less than 50 procedures per year.
Researchers wrote that their findings might help discover ways to limit patient exposure to morbidity and mortality associated with variability in surgical and procedural quality.
“One avenue by which to achieve this may be the concentration of high-risk procedures to high-volume centers staffed with experienced physicians,” they wrote. “In the diverse, multi-payer healthcare landscape of the U.S., centralization may be more challenging than in single-payer systems; however, the avoidance of unnecessary, costly hospitalizations may serve as a powerful market driven impetus for commercial payers to incent payment for quality healthcare delivery.” – by Alex Young
Disclosures: The authors report no relevant financial disclosures.
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