End-stage renal disease is associated with increased post endoscopic retrograde cholangiopancreatography adverse events in hospitalized patients. - 2018

AIM: To determine if end-stage renal disease (ESRD) is a risk factor for post endoscopic retrograde cholangiopancreatography (ERCP) adverse events (AEs). CONCLUSION: ESRD is a risk factor for post-ERCP AEs and is associated with higher hospital mortality. Careful selection and close monitoring is warranted to improve outcomes. METHODS: We performed a retrospective cohort study using the Nationwide Inpatient Sample (NIS) 2011-2013. We identified adult patients who underwent ERCP using the International Classification of Diseases 9th Revision (ICD-9-CM). Included patients were divided into three groups: ESRD, chronic kidney disease (CKD), and control. The primary outcome was post-ERCP AEs including pancreatitis, bleeding, and perforation determined based on specific ICD-9-CM codes. Secondary outcomes were length of hospital stay, in-hospital mortality, and admission cost. AEs and mortality were compared using multivariate logistic regression analysis. 82064 (95%CI: 3 RESULTS: There were 492175 discharges that underwent ERCP during the 3 years. The ESRD and CKD groups contained 7347 and 39403 hospitalizations respectively, whereas the control group had 445424 hospitalizations. Post-ERCP pancreatitis (PEP) was significantly higher in the ESRD group (8.3%) compared to the control group (4.6%) with adjusted odd ratio (aOR) = 1.7 (95%CI: 1.4-2.1, a P < 0.001). ESRD was associated with significantly higher ERCP-related bleeding (5.1%) compared to the control group 1.5% (aOR = 1.86, 95%CI: 1.4-2.4, a P < 0.001). ESRD had increased hospital mortality 7.1% vs 1.15% in the control OR = 6.6 (95%CI: 5.3-8.2, a P < 0.001), longer hospital stay with adjusted mean difference (aMD) = 5.9 d (95%CI: 5.0-6.7 d, a P < 0.001) and higher hospitalization charges aMD = 82064 (95%CI: a 82064 (95%CI: b 82064 (95%CI: u


English

1007-9327

10.3748/wjg.v24.i41.4691 [doi] PMC6224476 [pmc]


*Cholangiopancreatography, Endoscopic Retrograde/ae [Adverse Effects]
*Kidney Failure, Chronic/co [Complications]
*Pancreatitis/ep [Epidemiology]
*Postoperative Hemorrhage/ep [Epidemiology]
Aged
Female
Hospital Mortality
Humans
Length of Stay/ec [Economics]
Length of Stay/sn [Statistics & Numerical Data]
Male
Middle Aged
Pancreatitis/et [Etiology]
Postoperative Hemorrhage/et [Etiology]
Retrospective Studies
Risk Factors


MedStar Washington Hospital Center


Medicine/Gastroenterology


Journal Article