Early Endoscopic Retrograde Cholangiopancreatography is Associated With Improved Health Care Resource Utilization in...

The optimal timing for endoscopic retrograde cholangiopancreatography (ERCP) in managing uncomplicated acute biliary pancreatitis (ABP) remains unclear. This population-based study assessed the impact of ERCP timing on outcomes in hospitalized ABP patients without cholangitis or sepsis.

Using the Nationwide Readmission Database (2016 to 2020), patients with ABP who underwent ERCP were identified, excluding those with cholangitis/sepsis. ERCP timing was categorized as early (0 to 1 d) or delayed (2 to 7 d). Outcomes, including mortality, 30-day readmissions, and health care resource utilization were analyzed using multivariable logistic regression.

Among 54,250 noninfectious ABP patients, 42.13% underwent ERCP. There was no significant difference in in-hospital mortality between early and delayed ERCP groups (0.26% vs. 0.24%, P =0.73). However, 30-day readmission rates rose with each day of delay in the delayed ERCP group ( P <0.001) and were higher overall (8.26% vs. 7.51%, P =0.03). Delayed ERCP was associated with increased 30-day readmissions (OR: 1.11, 95% CI: 1.00-1.22); using alternate categorical thresholds, ERCP on day 4 or later was also linked to higher odds of readmission (OR: 1.35, 95% CI: 1.18-1.54). Early ERCP was associated with reduced mean length of stay by 1.51 days (95% CI: -1.51 to -1.50; P <0.001) and hospital costs by $1536.45 (95% CI: -$1545.37 to -$1527.52; P <0.001) after multivariable adjustment. Compared with day 4 or later, ERCP on days 2 to 3 further reduced stay by 2.42 days and costs by $3756.95 (both P <0.001).

Delayed ERCP was associated with increased 30-day readmission rates and greater health care resource utilization and ERCP performed within 4 days may improve hospital quality metrics in patients with noninfectious acute biliary pancreatitis.