High-Risk Comorbidities Drive Adverse Inpatient Outcomes After ERCP: A National Analysis and Predictive Model

Area of Science:

• Gastroenterology
• Nephrology
• Cardiology
• Hepatology

Background:

• Patients undergoing Endoscopic Retrograde Cholangiopancreatography (ERCP) with chronic kidney disease (CKD), congestive heart failure (CHF), or liver cirrhosis (LC) often experience poorer outcomes.
• The contribution of procedure-related events versus underlying comorbidities to these adverse outcomes remains unclear.

Purpose of the Study:

• To investigate the impact of high-risk comorbidities (CKD, CHF, LC) on inpatient outcomes following ERCP.
• To determine whether adverse events are primarily driven by the procedure itself or by pre-existing conditions.

Main Methods:

• Analysis of the National Inpatient Sample database to identify adult ERCP admissions.
• Definition of high-risk comorbidities as CKD, CHF, or LC.
• Evaluation of primary outcomes including inpatient mortality and morbidity, length of stay (LOS), and hospital charges.

Main Results:

• Nearly a quarter (22.8%) of 1,171,973 ERCP admissions involved patients with high-risk comorbidities.
• High-risk patients exhibited significantly higher inpatient mortality (3.8% vs. 0.8%) and morbidity (71.8% vs. 35.7%) compared to lower-risk patients.
• Adjusted models confirmed high-risk comorbidities independently predicted mortality (OR 3.80) and morbidity (OR 3.22), with LC being the strongest predictor of mortality and CHF of morbidity.

Conclusions:

• High-risk comorbidities are prevalent in ERCP admissions and are strong independent predictors of adverse inpatient outcomes.
• The majority of negative outcomes appear to stem from the severity of underlying illnesses rather than ERCP-specific complications.
• Validated predictive models can aid in patient counseling, triage, and peri-procedural management for high-risk ERCP patients.