869 A Comparison of ERCP Outcomes Between High Volume and Low Volume Centers

Abstract

INTRODUCTION: Endoscopic Retrograde Cholangiopancreatography (ERCP) is a commonly performed procedure for simultaneous diagnosis and treatment of biliary disease, which has several potential post-procedural complications. Few studies have addressed the association between hospital ERCP volume and post procedural complications. This study aims to examine the difference in the rate of post ERCP complications between high and low volume centers. METHODS: The study population was extracted from the 2016 Nationwide Readmissions Database using International Classification of Diseases, Tenth Revision, and Clinical Modification/Procedure Coding System for ERCP and in-hospital outcomes. Centers that performed > 200 ERCPs during the year of 2016 were considered high-volume, whereas centers that performed < 200 ERCPs were considered low-volume. Study endpoints included in-hospital all-cause mortality, length of hospital stay (LOS), post ERCP pancreatitis, and infection rates. RESULTS: A total of 137,825 ERCPs were identified, of which 39.8% were diagnostic ERCPs while 60.2% were therapeutic ERCPs. The mean age of patients was 59.7 years. 56.9% of the study population were female. High-volume centers performed 54,640 procedures while low-volume centers performed 83,185 procedures. In regards to complications, high-volume centers compared to low-volume centers, had a significantly higher rate of all-cause mortality (1.9% vs 1.4%, P < 0.01), post-op pancreatitis (7.0% vs 6.2%, P < 0.01), post-procedural infection (0.7% vs 0.5%, P < 0.01), and LOS (6.7 days vs 5.9 days, P < 0.01). This pattern was consistent for ERCP procedures performed for both diagnostic and therapeutic purposes, with the exception of similar rates of post-procedural pancreatitis associated with ERCP performed for diagnostic purposes in both high and low volume centers. CONCLUSION: In this preliminary analysis of a large database, hospitals with high ERCP volume were associated with a higher rate of complications including post procedural in-hospital mortality, morbidity, and length of stay. While procedural technique and operators vary amongst centers, we hypothesize that the higher rate of complications seen in patients being treated at high volume centers may, in part be due to a higher complexity in patients been seen at high volume centers.