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

Tarek Sawas, Fateh Bazerbachi, Samir Haffar, Won K. Cho, Michael J. Levy, John A. Martin, Bret Thomas Petersen, Mark Topazian, Vinay Chandrasekhara, Barham K. Abu Dayyeh

Research output: Contribution to journalArticle

Abstract

AIM To determine if end-stage renal disease (ESRD) is a risk factor for post endoscopic retrograde cholangio pancreatography (ERCP) adverse events (AEs). 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. 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, aP < 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, aP < 0.001). ESRD had increased hospital mortality 7.1% vs 1.15% in the control OR = 6.6 (95%CI: 5.3-8.2, aP < 0.001), longer hospital stay with adjusted mean difference (aMD) = 5.9 d (95%CI: 5.0-6.7 d, aP < 0.001) and higher hospitalization charges aMD = $+82064 (95%CI: $68221-$95906, aP < 0.001). 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.

Original languageEnglish (US)
Pages (from-to)4691-4697
Number of pages7
JournalWorld Journal of Gastroenterology
Volume24
Issue number41
DOIs
StatePublished - Nov 7 2018

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Endoscopic Retrograde Cholangiopancreatography
Chronic Kidney Failure
International Classification of Diseases
Hospital Mortality
Length of Stay
Hospitalization
Chronic Renal Insufficiency
Pancreatitis
Control Groups
Odds Ratio
Hemorrhage
Inpatients
Cohort Studies
Retrospective Studies
Logistic Models
Regression Analysis
Costs and Cost Analysis
Mortality

Keywords

  • End-stage renal disease
  • Endoscopic retrograde cholangiopancreatography
  • Nationwide Inpatient Sample

ASJC Scopus subject areas

  • Gastroenterology

Cite this

End-stage renal disease is associated with increased post endoscopic retrograde cholangiopancreatography adverse events in hospitalized patients. / Sawas, Tarek; Bazerbachi, Fateh; Haffar, Samir; Cho, Won K.; Levy, Michael J.; Martin, John A.; Petersen, Bret Thomas; Topazian, Mark; Chandrasekhara, Vinay; Abu Dayyeh, Barham K.

In: World Journal of Gastroenterology, Vol. 24, No. 41, 07.11.2018, p. 4691-4697.

Research output: Contribution to journalArticle

Sawas, Tarek ; Bazerbachi, Fateh ; Haffar, Samir ; Cho, Won K. ; Levy, Michael J. ; Martin, John A. ; Petersen, Bret Thomas ; Topazian, Mark ; Chandrasekhara, Vinay ; Abu Dayyeh, Barham K. / End-stage renal disease is associated with increased post endoscopic retrograde cholangiopancreatography adverse events in hospitalized patients. In: World Journal of Gastroenterology. 2018 ; Vol. 24, No. 41. pp. 4691-4697.
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abstract = "AIM To determine if end-stage renal disease (ESRD) is a risk factor for post endoscopic retrograde cholangio pancreatography (ERCP) adverse events (AEs). 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. 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, aP < 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, aP < 0.001). ESRD had increased hospital mortality 7.1{\%} vs 1.15{\%} in the control OR = 6.6 (95{\%}CI: 5.3-8.2, aP < 0.001), longer hospital stay with adjusted mean difference (aMD) = 5.9 d (95{\%}CI: 5.0-6.7 d, aP < 0.001) and higher hospitalization charges aMD = $+82064 (95{\%}CI: $68221-$95906, aP < 0.001). 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.",
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T1 - End-stage renal disease is associated with increased post endoscopic retrograde cholangiopancreatography adverse events in hospitalized patients

AU - Sawas, Tarek

AU - Bazerbachi, Fateh

AU - Haffar, Samir

AU - Cho, Won K.

AU - Levy, Michael J.

AU - Martin, John A.

AU - Petersen, Bret Thomas

AU - Topazian, Mark

AU - Chandrasekhara, Vinay

AU - Abu Dayyeh, Barham K.

PY - 2018/11/7

Y1 - 2018/11/7

N2 - AIM To determine if end-stage renal disease (ESRD) is a risk factor for post endoscopic retrograde cholangio pancreatography (ERCP) adverse events (AEs). 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. 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, aP < 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, aP < 0.001). ESRD had increased hospital mortality 7.1% vs 1.15% in the control OR = 6.6 (95%CI: 5.3-8.2, aP < 0.001), longer hospital stay with adjusted mean difference (aMD) = 5.9 d (95%CI: 5.0-6.7 d, aP < 0.001) and higher hospitalization charges aMD = $+82064 (95%CI: $68221-$95906, aP < 0.001). 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.

AB - AIM To determine if end-stage renal disease (ESRD) is a risk factor for post endoscopic retrograde cholangio pancreatography (ERCP) adverse events (AEs). 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. 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, aP < 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, aP < 0.001). ESRD had increased hospital mortality 7.1% vs 1.15% in the control OR = 6.6 (95%CI: 5.3-8.2, aP < 0.001), longer hospital stay with adjusted mean difference (aMD) = 5.9 d (95%CI: 5.0-6.7 d, aP < 0.001) and higher hospitalization charges aMD = $+82064 (95%CI: $68221-$95906, aP < 0.001). 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.

KW - End-stage renal disease

KW - Endoscopic retrograde cholangiopancreatography

KW - Nationwide Inpatient Sample

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