Unavailability of Endoscopic Retrograde Cholangiography Adversely Impacts Hospital Outcomes of Acute Biliary Pancreatitis

Autor: Darwin L. Conwell, Somashekar G. Krishna, J. Royce Groce, Alice Hinton, Claire Durkin, Ahmad Malli
Rok vydání: 2020
Předmět:
Male
medicine.medical_specialty
genetic structures
Endocrinology
Diabetes and Metabolism
digestive system
Cohort Studies
03 medical and health sciences
0302 clinical medicine
Endocrinology
Surveys and Questionnaires
Outcome Assessment
Health Care
Internal Medicine
Humans
Medicine
Biliary pancreatitis
Propensity Score
Cholangiopancreatography
Endoscopic Retrograde
Endoscopic retrograde cholangiopancreatography
Hepatology
medicine.diagnostic_test
business.industry
General surgery
Middle Aged
digestive system diseases
Hospitalization
Biliary Tract Surgical Procedures
Logistic Models
surgical procedures
operative
Pancreatitis
Hospital outcomes
030220 oncology & carcinogenesis
Acute Disease
Multivariate Analysis
Propensity score matching
Endoscopic retrograde cholangiography
Female
030211 gastroenterology & hepatology
Unavailability
business
Zdroj: Pancreas. 49:39-45
ISSN: 1536-4828
0885-3177
Popis: There is a paucity of literature assessing the impact of endoscopic retrograde cholangiopancreatography (ERCP) availability at hospitals and the management of acute biliary pancreatitis (ABP). Thus, we sought to evaluate the impact of ERCP availability on the clinical outcomes of ABP.The Nationwide Inpatient Sample (2004-2013) was reviewed to identify adult inpatients (≥18 years) with ABP. Clinical outcomes (mortality, severe acute pancreatitis, and health care resource utilization) between hospitals that perform ERCP versus hospitals that do not perform ERCP were compared using multivariate and propensity score-matched analyses.A majority of the non-ERCP hospitals were rural (73%) in location. Multivariate analysis demonstrated that the lack of ERCP availability was independently associated with increased mortality from ABP (odds ratio, 1.83; 95% confidence interval, 1.16-2.88). A propensity score-matched cohort analysis confirmed a significant increase in mortality from ABP in non-ERCP hospitals (1.1% vs 0.53%; odds ratio, 2.08; 95% confidence interval, 1.05-4.15, P = 0.037) compared with ERCP hospitals.This national survey reveals increased mortality for patients with ABP admitted to hospitals lacking ERCP services. While there is a need to increase ERCP availability in rural areas, optimizing strategies for early transfer of patients with ABP to hospitals with ERCP availability can potentially offset these limitations.
Databáze: OpenAIRE
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