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Early vs late endoscopic retrograde cholangiopancreatography in patients with acute cholangitis: A nationwide analysis

AIM: To assess the effect of early vs late endoscopic retrograde cholangiopancreatography (ERCP) on mortality and readmissions in acute cholangitis, using a nationally representative sample. METHODS: We used the 2014 National Readmissions Database to identify adult patients hospitalized with acute c...

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Autores principales: Mulki, Ramzi, Shah, Rushikesh, Qayed, Emad
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6354111/
https://www.ncbi.nlm.nih.gov/pubmed/30705731
http://dx.doi.org/10.4253/wjge.v11.i1.41
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author Mulki, Ramzi
Shah, Rushikesh
Qayed, Emad
author_facet Mulki, Ramzi
Shah, Rushikesh
Qayed, Emad
author_sort Mulki, Ramzi
collection PubMed
description AIM: To assess the effect of early vs late endoscopic retrograde cholangiopancreatography (ERCP) on mortality and readmissions in acute cholangitis, using a nationally representative sample. METHODS: We used the 2014 National Readmissions Database to identify adult patients hospitalized with acute cholangitis who underwent therapeutic ERCP within one week of admission. Early ERCP was defined as ERCP performed on the same day of admission or the next day (days 0 or 1, < 48 h), and late ERCP was performed on days 2 to 7 of admission. Patients with severe cholangitis had any of the following additional diagnoses: Severe sepsis, septic shock, acute renal failure, acute respiratory failure, or thrombocytopenia. Multivariate logistic regression was used to calculate the adjusted odds of association of ERCP timing with in-hospital mortality, 30-d mortality, and 30-d readmissions, controlling for age, sex, severe disease and comorbidities. RESULTS: Four thousand five hundred and seventy patients satisfied the inclusion criteria; with a mean age of 64.1 years. Of these, 66.6% had early ERCP, while 33.4% had late ERCP. Early ERCP was associated with lower in-hospital mortality [1.2% vs 2.4%, adjusted odds ratio (aOR) = 0.50, 95%CI: 0.76-0.83, P = 0.001] and lower 30-d mortality (1.5% vs 3.3%, aOR = 0.48, 95%CI: 0.33-0.69, P < 0.0001) compared to the late ERCP group. Similarly, early ERCP was associated with lower 30-d readmissions (9.7% vs 15.1%, aOR = 0.58, 95%CI: 0.49-0.7, P < 0.0001). When stratified by severity of cholangitis, there was a similar benefit of early ERCP on all outcomes in those with and without severe cholangitis. The mean length of stay was higher in the late ERCP group compared to the early ERCP group (6.9 d vs 4.5 d, P < 0.0001). The mean hospitalization cost was higher in the late ERCP group ($21459 vs $16939, P < 0.0001). CONCLUSION: Early ERCP is associated with lower in-hospital and 30-d mortality in those with or without severe cholangitis. Regardless of severity, we suggest performing early ERCP.
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spelling pubmed-63541112019-01-31 Early vs late endoscopic retrograde cholangiopancreatography in patients with acute cholangitis: A nationwide analysis Mulki, Ramzi Shah, Rushikesh Qayed, Emad World J Gastrointest Endosc Retrospective Study AIM: To assess the effect of early vs late endoscopic retrograde cholangiopancreatography (ERCP) on mortality and readmissions in acute cholangitis, using a nationally representative sample. METHODS: We used the 2014 National Readmissions Database to identify adult patients hospitalized with acute cholangitis who underwent therapeutic ERCP within one week of admission. Early ERCP was defined as ERCP performed on the same day of admission or the next day (days 0 or 1, < 48 h), and late ERCP was performed on days 2 to 7 of admission. Patients with severe cholangitis had any of the following additional diagnoses: Severe sepsis, septic shock, acute renal failure, acute respiratory failure, or thrombocytopenia. Multivariate logistic regression was used to calculate the adjusted odds of association of ERCP timing with in-hospital mortality, 30-d mortality, and 30-d readmissions, controlling for age, sex, severe disease and comorbidities. RESULTS: Four thousand five hundred and seventy patients satisfied the inclusion criteria; with a mean age of 64.1 years. Of these, 66.6% had early ERCP, while 33.4% had late ERCP. Early ERCP was associated with lower in-hospital mortality [1.2% vs 2.4%, adjusted odds ratio (aOR) = 0.50, 95%CI: 0.76-0.83, P = 0.001] and lower 30-d mortality (1.5% vs 3.3%, aOR = 0.48, 95%CI: 0.33-0.69, P < 0.0001) compared to the late ERCP group. Similarly, early ERCP was associated with lower 30-d readmissions (9.7% vs 15.1%, aOR = 0.58, 95%CI: 0.49-0.7, P < 0.0001). When stratified by severity of cholangitis, there was a similar benefit of early ERCP on all outcomes in those with and without severe cholangitis. The mean length of stay was higher in the late ERCP group compared to the early ERCP group (6.9 d vs 4.5 d, P < 0.0001). The mean hospitalization cost was higher in the late ERCP group ($21459 vs $16939, P < 0.0001). CONCLUSION: Early ERCP is associated with lower in-hospital and 30-d mortality in those with or without severe cholangitis. Regardless of severity, we suggest performing early ERCP. Baishideng Publishing Group Inc 2019-01-16 2019-01-16 /pmc/articles/PMC6354111/ /pubmed/30705731 http://dx.doi.org/10.4253/wjge.v11.i1.41 Text en ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.
spellingShingle Retrospective Study
Mulki, Ramzi
Shah, Rushikesh
Qayed, Emad
Early vs late endoscopic retrograde cholangiopancreatography in patients with acute cholangitis: A nationwide analysis
title Early vs late endoscopic retrograde cholangiopancreatography in patients with acute cholangitis: A nationwide analysis
title_full Early vs late endoscopic retrograde cholangiopancreatography in patients with acute cholangitis: A nationwide analysis
title_fullStr Early vs late endoscopic retrograde cholangiopancreatography in patients with acute cholangitis: A nationwide analysis
title_full_unstemmed Early vs late endoscopic retrograde cholangiopancreatography in patients with acute cholangitis: A nationwide analysis
title_short Early vs late endoscopic retrograde cholangiopancreatography in patients with acute cholangitis: A nationwide analysis
title_sort early vs late endoscopic retrograde cholangiopancreatography in patients with acute cholangitis: a nationwide analysis
topic Retrospective Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6354111/
https://www.ncbi.nlm.nih.gov/pubmed/30705731
http://dx.doi.org/10.4253/wjge.v11.i1.41
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