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Nationwide Evolution of Pediatric Endoscopic Retrograde Cholangiopancreatography Indications, Utilization, and
Monique T Barakat1, George Cholankeril2, Roberto Gugig3
1Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Lucille Packard Children's Hospital at Stanford University Medical Centerr, Stanford, CA; Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA.
Insights
Pediatric endoscopic retrograde cholangiopancreatography (ERCP) utilization increased, with 13% of patients readmitted post-procedure. Risk factors for readmission included younger age, male sex, obesity, and liver transplant history.
Area of Science:
- Gastroenterology
- Pediatric Gastroenterology
- Health Services Research
Background:
- Pediatric endoscopic retrograde cholangiopancreatography (ERCP) is a crucial diagnostic and therapeutic tool.
- Understanding national trends in its utilization and outcomes is vital for optimizing pediatric care.
- Limited data exists on nationwide pediatric ERCP trends and associated readmission rates.
Purpose of the Study:
- To analyze the trends in utilization and outcomes of pediatric ERCP in the United States.
- To identify predictors of 30-day readmission following pediatric ERCP.
- To examine patient and hospital characteristics associated with ERCP outcomes.
Main Methods:
- Utilized the National Inpatient Sample (2005-2014) and National Readmission Database (2010-2014).
- Identified pediatric hospitalizations (<20 years) undergoing ERCP.
- Employed multivariate logistic regression to identify predictors of 30-day readmission.
Main Results:
- 11,060 pediatric ERCPs were performed, predominantly therapeutic (85%) for biliary or pancreatitis indications.
- Readmission rates were 13%, with higher odds in younger children (0-4 years), males, obese patients, and those with liver transplants.
- Urban teaching and urban hospitals showed lower odds of prolonged length of stay compared to rural hospitals.
Conclusions:
- This study provides comprehensive nationwide data on pediatric ERCP volume, outcomes, and readmission trends.
- Identified key patient and hospital factors influencing pediatric ERCP outcomes.
- Offers insights for improving management of pediatric pancreaticobiliary diseases and post-ERCP care.
Objectives:
To analyze outcome and utilization trends over time of pediatric endoscopic retrograde cholangiopancreatography (ERCP) in an all-capture US population-level study.
Study Design:
Using the National Inpatient Sample (2005-2014) and National Readmission Database (2010-2014), we identified pediatric (age <20 years) hospitalizations during which ERCP was performed and assessed ERCP-associated readmissions. International Classification of Diseases, Ninth Revision, Clinical Modification codes were used to identify hospitalization diagnoses, comorbidities, and patient/hospital characteristics. Multivariate logistic regression analyses were performed to determine significant predictors (P < .05) of 30-day readmission.
Results:
A total of 11 060 hospitalized pediatric patients underwent ERCP between 2005 and 2014. Most were female (n = 8859; 81%), aged 14-20 years (n = 9342; 84%), and white (n = 4230; 45%). Most (85%) of ERCPs were therapeutic, and leading indications were biliary (n = 5350; 48%) and pancreatitis (n = 3218; 29%). Thirteen pecent of patients were readmitted post-ERCP. Odds for 30-day readmission were highest for patients with a history of liver transplantation, age 0-4 years, male sex, and obesity (P < .001 for each). Patients in both urban teaching and urban hospitals had much lower odds than those in rural hospitals for prolonged length of stay associated with ERCP.
Conclusions:
These data represent a comprehensive study of nationwide trends in age-specific volumes and outcomes following ERCP in the pediatric population and provide important insights into trends in pediatric pancreaticobiliary disease management, as well as practice setting, patient characteristics, and patient comorbidities associated with pediatric post-ERCP outcomes, including readmission and length of stay.
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