170 Post ERCP de novo fever and de novo bacteremia: Insights from the national inpatient database
Bhurwal A, Mutneja HR, Haq KF, Bartel M, and Brahmbhatt B. 170 POST ERCP DE NOVO FEVER AND DE NOVO BACTEREMIA: INSIGHTS FROM NATIONAL INPATIENT DATABASE. Gastrointestinal Endoscopy 2019; 89(6):AB55.
Background: The aim of the study was to assess the incidence of post ERCP fever and bacteremia in the national cohort. The secondary aims were to evaluate the in-hospital mortality, length of stay and total hospitalization charges. Methods: This was a retrospective cohort study using the 2016 Nationwide Inpatient Sample (NIS). Patients with ICD-10 CM procedure codes for ERCP were included. Patients were excluded from the study if they had an ICD-10 CM code for a principal diagnosis of acute cholangitis and principal diagnosis of sepsis. Post-ERCP bacteremia was defined as an ICD-10 CM code for a secondary diagnosis of infection or septic shock or fever in patients who received an ERCP. Primary outcome was incidence of post-ERCP bacteremia. Secondary outcomes included in-hospital mortality, length of stay (LOS)and total hospitalization charges. Proportions were compared using fisher’s exact test and continuous variables using student t-test. Multivariable and Poisson regression was performed. Results: We included a total of 152,924 ERCP procedures which were performed in hospitals in the year 2016 across the US. Fever with no signs of bacteremia or sepsis after ERCP was noticed in 0.2% of the population. Post ERCP bacteremia was noticed in 0.5% of all the procedures. 9% of patients with sepsis after ERCP progressed to septic shock. Hispanics were less likely to develop signs of sepsis versus fever alone after ERCP (15% vs 21%, p<0.001)which persisted after adjustment of confounders. ERCP with placement of biliary stent and pancreatic stent was associated with increased odds of developing de novo sepsis by 3 times and 5 times respectively. There was no significant difference in terms of post ERCP percutaneous cholecystectomy or bile duct exploration in the two cohorts. Fever alone did not increase the odds of mortality. However, mortality risk is increased by almost 3 times after the development of sepsis (OR 2.96 (1.36-6.46), p = 0.006). The mean length of stay was significantly higher in patients with post ERCP bacteremia as compared to fever with no sepsis (8 days vs 16 days, p<0.001)which was significant even after adjustment of confounders for Poisson regression. Post ERCP bacteremia is associated with higher total hospitalization charges (114,381 $ vs 188,835 $, p<0.001). Discussion/conclusion: The study shows that occurrence of fever and post ERCP sepsis from national database is 0.7%. Febrile episode after ERCP leads to prolonged stay which might indicate physicians being cautious. Further studies are warranted to determine any racial and genetic differences, given that hispanics had lower incidence of progression to sepsis. Placement of biliary stent and pancreatic stent were associated with increased progression and therefore further studies might be needed to elucidate which patients might benefit from prophylactic antibiotics. [Figure presented][Figure presented]