Thirty-day incidence of post-ERCP complications: Incidence, risk factors and outcomes
Bhurwal A, Mutneja HR, Haq KF, Solanki S, Chandra Chakinala R, Bartel MJ, and Brahmbhatt B. Thirty-day incidence of post-ERCP complications: Incidence, risk factors and outcomes. Gastrointestinal Endoscopy 2020; 91(6):AB355.
Introduction: Endoscopic Retrograde Cholangiopancreatography often leads to mortality and morbidity with complications such as post procedure bleeding, post procedure laceration and post procedure hematoma. Currently, there are no national studies to determine the incidence of these complications and impact on health care utilization in terms of readmissions. Therefore, we aim to assess the national incidence of post ERCP hemorrhage, laceration and hematoma. The secondary aims of the study were to identify the readmissions associated with such complications and evaluate differences in the index admissions in terms of demographics, procedural differences. Methods: This was a retrospective cohort study using the National Readmission Database for the year 2016. Discharges with International Classification of Diseases,10th Revision, Clinical Modification (ICD-10-CM) procedures codes for ERCP were included. Post ERCP complications such as post procedure laceration, hematoma and hemorrhage were defined as an ICD-10-CM code for the same. Subsequently, 30-day readmissions were then calculated for readmissions focusing on post ERCP fever and post ERCP bacteremia. Primary aims were to evaluate the incidence of complications during index admission and readmission. We also aimed to analyze demographic and procedure differences leading to complications. All statistical analysis was performed using STATA software. Results: We analyzed a total of 135,905 discharges undergoing ERCPs for diagnostic and therapeutic purposes. Out of these, 8 cases of post procedure hematoma per 1,000 ERCP were noticed during index admission. Similarly, incidence of post procedure laceration was 3.5/1,000 ERCP cases and post procedure bleeding was 6 per 1,000 ERCPs during the index admission. Approximately, 11.35% of these discharges were readmitted within 30 days of discharge indicating early readmission. However, complications of ERCP leading to readmissions were infrequent. Out of the discharges, post procedure hematoma was reported in 1.4 per 1,000 ERCPs, post procedure laceration in 1.07 per 1,000 ERCPs and post procedure hematoma in 1.07 per 1,000 ERCPs. The occurrence of post procedure complications had higher frequency of PTC or bile duct exploration. As expected, the length of stay and total hospitalization charges were also higher. Discussion: In a retrospective study, the occurrence of post ERCP complications such as post procedure hematoma, post procedure laceration and post procedure hemorrhage were less than 1%. Majority of the complications were noticed during the index admission. Early readmissions after index admission with ERCP for the complications are also infrequent. These suggest that the adverse effects with ERCP are relatively low with low effect on health care utilization. Further studies are warranted to determine the specific risk factors for the complications.