Trend and Predictors of the Utilization of Endoscopic Retrograde Cholangiopancreatography in Acute Pancreatitis Hospitalizations

Background Acute pancreatitis is a sudden inflammation of the pancreas, and biliary pancreatitis remains the most common cause of acute pancreatitis. Endoscopic retrograde cholangiopancreatography (ERCP) is both a diagnostic and therapeutic invasive procedure to evaluate and treat pancreaticobiliary system diseases. ERCP is very commonly used in acute pancreatitis with coexisting acute cholangitis or biliary obstruction. There was a need for a nationwide study to evaluate ERCP utilization trends and health-care costs among acute pancreatitis patients. Aim We sought to determine the prevalence trend, hospitalization cost and stay, and predictors of utilization of ERCP amongst patients with acute pancreatitis. Methods We performed a population-based retrospective analysis of national data in adult acute pancreatitis hospitalizations. We evaluated the characteristics of the ERCP cohort, prevalence trend, and hospital utilization cost and stay using univariate analysis. Multivariable survey logistic regression analysis was performed to evaluate predictors of utilization for ERCP among acute pancreatitis hospitalization. Results Among 2,632,309 hospitalizations for acute pancreatitis, 49108 (1.87%) had ERCP. The prevalence trend of ERCP declined from 3.88% in 2003 to 0.97% in 2014.(p(Trend)<0.0001). Patients with ERCP were older (>55-years old) (53.01% vs 39.36%;p<0.0001), female (58.45% vs 48.04%; p<0.0001), Hispanic (16.30% vs 12.86%; p<0.0001), utilizing Medicare (40.29% vs 31.88%; p<0.0001), elective admission (8.15% vs 4.98%; p<0.0001), and with gallbladder etiology (65.98% vs 26.06%; p<0.0001). Acute pancreatitis hospitalization with ERCP had a higher cost of utilization (Cost(diff):+$25077;p<0.0001) and mean stay (LOS(diff):+3.5 days; p<0.0001). In regression analysis, old adults [Odds ratio(OR):1.087; Confidence interval (CI):1.008-1.173), Hispanic (OR:1.086; CI:1.019-1.156), asian (OR:1.146; CI:1.007-1.304), female (OR:1.074; CI:1.028-1.122), elective admission (OR:1.649; CI:1.524-1.785), gallbladder etiology (OR:4.437; CI:4.224-4.662), concurrent chronic pancreatitis (OR:1.643; CI:1.536-1.757), systemic inflammatory response syndrome (SIRS) (OR:1.264; CI:1.112-1.436), pleural effusion (OR:1.874; CI:1.231-2.854), and portal vein thrombosis (OR:1.646; CI:1.221-2.219). Conclusion In nationwide data, we have found a decreased utilization trend and higher hospital utilization cost and stay associated with ERCP. The predictors of utilization will be helpful to examine the cost-utility of ERCP, especially with the advent of acute pancreatitis treatment systems to mitigate the health care burden.