Decreasing mortality from acute biliary diseases that require endoscopic retrograde cholangiopancreatography: A nationwide cohort study

Paul D. James, Gilaad G. Kaplan, Robert P. Myers, James Hubbard, Abdel Aziz Shaheen, Jill Tinmouth, Elaine Yong, Jonathan Love, Steven J. Heitman

Research output: Contribution to journalArticle

Abstract

Background & Aims: The management of acute biliary diseases often involves endoscopic retrograde cholangiopancreatography (ERCP), but it is not clear whether this technique reduces mortality. We investigated whether mortality from acute biliary diseases that require ERCP has been reduced over time and explored factors associated with mortality. Methods: We conducted a cohort study using the Nationwide Inpatient Sample (1998-2008). We identified hospitalizations for choledocholithiasis, cholangitis, and acute pancreatitis that involved ERCP. Multivariate analyses were used to determine the effects of time period, patient factors, hospital characteristics, features of the ERCP procedure, and types of cholecystectomies on mortality, length of stay, and costs. Results: From 1998 to 2008 there were 166,438 admissions for acute biliary conditions that met the inclusion criteria, corresponding to more than 800,000 patients nationwide. During this interval, mortality decreased from 1.1% to 0.6% (adjusted odds ratio [aOR], 0.7; 95% confidence interval [CI], 0.6-0.8), diagnostic ERCPs decreased from 28.8% to 10.0%, hospitals performing fewer than 100 ERCPs per year decreased from 38.4% to 26.9%, open cholecystectomies decreased from 12.4% to 5.8%, and unsuccessful ERCPs decreased from 6.3% to 3.2% (P

Original languageEnglish (US)
JournalClinical Gastroenterology and Hepatology
Volume12
Issue number7
DOIs
StatePublished - 2014
Externally publishedYes

Keywords

  • Cohort study
  • Death
  • ERCP
  • Outcomes

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

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