Impact of Trainee Involvement on Outcomes in Acute Cholangitis: A Propensity-Matched Study in U.S. Hospitals

This study analyzed the outcomes of acute cholangitis (AC) in teaching hospitals, comparing July-September (new trainees) to April-June (experienced trainees). The July trainee transition may increase errors and inefficiencies despite diligent staff efforts. Outcomes were evaluated to determine the impact of trainee experience on patient care during these critical educational periods.

This study analyzed adult hospitalizations (age >18) with AC in U.S. teaching hospitals using the National Inpatient Sample (2016-2020). A retrospective multivariate analysis was conducted using SAS 9.4 to evaluate inpatient mortality, length of stay (LOS), total hospitalization cost (THC, adjusted to 2020 USD), critical care interventions (e.g., intubation, ICU admission, CVC placement), endoscopic retrograde cholangiopancreatography (ERCP) utilization (with/without intervention), and ERCP timing from admission.

A total of 12,360 patients were included in this analysis. Of those, 6355 (~51.42%) were admitted during July-Sept and 6005 (~48.58%) were admitted during April-June across a five-year period (2016-2020) in the United States. The median age of the patients was 73 years (IQR: 61-83) and 72 years (IQR: 61-83) for the period of July-Sept and April-June, respectively. Primary outcomes showed no difference in terms of in-patient mortality between the two groups (3.49% vs. 2.95%, p=0.1061). THC was slightly higher in the April-June group ($15,492 vs. $14,553) than in the July-Sept group. There were significantly higher rates of ICU admissions (6.26% vs. 4.83%, p=0.0009) and intubation (5.09% vs. 3.75%, p=0.0006) for patients who were managed during the months of July-Sept compared to those managed in April-June. However, there was no difference between two groups requiring central venous catheter (CVC) line placement (1.88% vs. 1.79%, p=0.7245) and ERCP utilization (85.17% vs. 85.25%, p=0.8941). Analysis revealed that the majority of patients had ERCP between 24 and 48 hours of admission in both groups (51.09% vs. 50.03%), than within 24 hours (25.42% vs. 25.02%) and after 48 hours (23.48% vs. 24.85%). However, there was no significant difference in timing between the two groups.

AC has no significant difference in mortality, LOS, THC, ERCP utilization, or ERCP timing between the two groups. However, patients managed from July to September experienced higher rates of ICU admissions and intubations compared to those managed from April to June. This may indicate a lower threshold for critical interventions due to trainee inexperience, with higher life-sustaining intervention rates driven by heightened patient safety measures to prevent errors.