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Expanding the Use of Endoscopic Retrograde Cholangiopancreatography in Pediatrics: A National Database Analysis of
Eric Lorio1, Chris Moreau2, Joel Edmund Michalek3
1Department of Gastroenterology and Hepatology, Tulane University School of Medicine, New Orleans, LA, USA.
Insights
Pediatric endoscopic retrograde cholangiopancreatography (ERCP) is safe, with low complication rates. Younger children (age ≤ 5) and males experienced longer hospital stays and more complex healthcare courses.
Area of Science:
- Pediatric Gastroenterology
- Medical Informatics
- Health Services Research
Background:
- Pediatric endoscopic retrograde cholangiopancreatography (ERCP) is a common procedure.
- Risk assessment for pediatric ERCP candidates requires understanding complication rates.
- National data can inform risk stratification for pediatric ERCP.
Purpose of the Study:
- To assess pediatric ERCP complication rates using a national database.
- To identify patient characteristics influencing ERCP complication risks in children.
- To improve risk assessment for pediatric ERCP candidates.
Main Methods:
- Utilized the Kids' Inpatient Database (KID), a national pediatric discharge sample.
- Employed International Classification of Diseases (ICD) codes to identify ERCP indications and complications.
- Performed statistical analyses using SAS 9.4 to evaluate complication rates and patient factors.
Main Results:
- Overall ERCP complication rate was 5.4%, with mortality < 0.2%.
- Gallbladder calculus and cholecystitis were more frequent in females.
- Patients aged 0-5 and males showed longer lengths of stay and lower routine home discharge rates.
Conclusions:
- Pediatric ERCP demonstrates a favorable safety profile with low complication and mortality rates.
- Significant variations in procedure indications exist across pediatric age groups, races, and genders.
- Younger children (≤ 5 years) and males faced more complex healthcare outcomes post-ERCP.
Background:
This study aimed to aid in risk assessment of pediatric endoscopic retrograde cholangiopancreatography (ERCP) candidates by utilizing a national pediatric database with a large sample to assess how patient characteristics may affect ERCP complication rates.
Methods:
The Kids' Inpatient Database (KID) is a sample of pediatric discharges in states participating in the Healthcare Cost and Utilization Project (HCUP). This database provides demographic information, hospitalization duration, and outcome information for hospitalizations during which an ERCP occurred. International Classification of Diseases (ICD) codes were used to determine the hospitalization indication. ERCP complication rate was ascertained via ICD codes. All statistical analyses were performed using SAS 9.4.
Results:
Complications were seen in 5.4% of hospitalizations with mortality observed in less than 0.2%. This analysis captured a large Hispanic population, specifically in the South and West regions. Gallbladder calculus and cholecystitis were more likely to occur in females. A higher percentage of patients in the age 10 - 17 group were female (72.2% vs. 52.7%, P < 0.01) and Hispanic (33.4% vs. 22.7%, P < 0.01) compared to the age 0 - 9 group. Age 0 - 5 and male gender were associated with lower routine home discharge rates and longer lengths of stay. Complications occurred at a higher rate in ages 0 - 5, though the difference was not statistically significant.
Conclusions:
ERCP is a safe procedure for pediatric patients with low complication rates and rare mortality. We found statistically significant differences in the procedure indications between pediatric age groups, races, and genders. Age ≤ 5 years and male gender were associated with more complicated healthcare courses.
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