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Effect of hospital teaching status on endoscopic retrograde cholangiopancreatography mortality and complications in the USA

Abstract

Background

Our aim was to assess the differences in outcomes of cholecystitis, pancreatitis, gastrointestinal (GI) bleed, GI perforation, and mortality in teaching versus nonteaching hospitals nationwide among therapeutic and diagnostic ERCPs. We hypothesized that complication rates would be higher in teaching hospitals given greater patient complexity.

Methods

Inpatient diagnostic and therapeutic ERCPs were identified from the National Inpatient Sample (NIS) from 2008 to 2012. The presence of ACGME-approved residency programs is required to qualify as a teaching hospital. Nonteaching urban and rural hospitals were grouped together. We identified hospital stays complicated by pancreatitis, cholecystitis, GI hemorrhage, perforation, and mortality. Logistic regression propensity-matched analysis was performed in SPSS to compare differences in complication rates between teaching and nonteaching hospitals.

Results

A total of 1,466,356 weighted cases of inpatient ERCPs were included in this study: of those, 367 and188 were diagnostic, 1,099,168 were therapeutic, 766,230 were at teaching hospitals, and 700,126 were at nonteaching hospitals. Mortality rates were higher in teaching hospitals when compared to nonteaching hospitals for diagnostic (OR 1.266, p < 0.001) and therapeutic ERCPs (OR 1.157, p = 0.001). There was no significant difference in rates of post-ERCP cholecystitis, pancreatitis, or perforation between the two groups. Among diagnostic ERCPs, GI hemorrhage was higher in teaching compared to nonteaching hospitals (OR 1.181, p = 0.003). Likewise, length of stay was increased in teaching hospitals (7.9 vs 6.9 days, p < 0.001, for diagnostic and 6.5 vs 5.8 days, p < 0.001, for therapeutic ERCPs).

Conclusions

In conclusion, teaching hospitals were noted to have a higher mortality rate associated with inpatient ERCPs as well as higher rates of GI hemorrhage in diagnostic ERCPs, which may be due to a higher comorbidity index in those patients admitted to teaching hospitals.

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Acknowledgements

We thank Richard Hajjar, MD for his insight and assistance with the statistical analysis.

Author information

Conception and design: all authors. Acquisition, analysis, and interpretation of data: all authors. Drafting of the manuscript: all authors. Critical revision of the manuscript for important intellectual content: all authors. Statistical analysis: LR and FA. Administrative, technical, or material support: all authors. Study supervision: SA. All authors approved the final version of the manuscript.

Correspondence to Laura Rotundo.

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Authors Laura Rotundo, Faiz Afridi, Mirela Feurdean and Sushil Ahlawat have no conflict of Interest or financial ties to disclose.

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Rotundo, L., Afridi, F., Feurdean, M. et al. Effect of hospital teaching status on endoscopic retrograde cholangiopancreatography mortality and complications in the USA. Surg Endosc (2020). https://doi.org/10.1007/s00464-020-07403-z

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Keywords

  • Endoscopic retrograde cholangiopancreatography
  • Hospital teaching status
  • Inpatient trends
  • Mortality