Abstract No. 581 Percutaneous biliary interventions: national trends, patient characteristics, clinical indications, and outcomes in the United States, 1993 to 2015

Abstract

to explore the national trends, patient characteristics, clinical indications and outcomes for percutaneous biliary interventions in the United States, 1993 – 2015. Inpatient stays associated with percutaneous transhepatic cholangiogram (PTC), percutaneous extraction of common duct stones and percutaneous biliary drainage (PBD) were studied using the data from the National Inpatient Sample. Patient characteristics, outcomes and primary discharge diagnoses were extracted. The overall rate of inpatient PBDs has modestly increased (0.5% per year) since 1993 while the rate of inpatient PTCs have remained stable. Meanwhile, the rate of percutaneous common duct stone extractions has markedly decreased (-7.8% annual change). In terms of outcomes, there has been a significant decrease in in-hospital mortality (-4.1% for PTC and -4.8% for PBD; P <0.05) and length of stay (-1.2 and -1.5 days for PTC and PBD; P <0.05). Total hospital charge has increased from $14,990 for PTC and $17,478 for PBD to $70,629 and $71,383, respectively (P <0.05) and fewer patients are having routine discharge (-23.5% and -19.5%; P <0.05). Biliary and pancreatic disorders (24.9% for PTC, 33.2% for PBD), malignancy (26.4% for PTC, 26.6% for PBD), postoperative complications (19.1% for PTC, 16.1% for PBD) and sepsis (12.8% for PTC, 10.9% for PBD), were the most common discharge diagnoses. Compared to patients with biliary/pancreatic disorders (including cholecystitis, cholelithiasis, cholangitis, bile duct obstruction and pancreatitis), sepsis and malignancy were associated with increased risk of mortality (Adjusted OR: 5.2 [3.9 – 7.0] for sepsis, 2.3 [1.7 – 3.0] for malignancy), lengthy hospital stay (Adjusted OR: 2.2 [1.9 – 2.5] for sepsis, 1.6 [1.4 – 1.8] for malignancy) and greater total hospital charges (Adjusted OR: 2.4 [2.1 – 2.8] for sepsis, 1.5 [1.4 – 1.7] for malignancy. There has been a significant decrease in mortality, length of stay, and routine disposition among patients undergoing PTC and PBD, while the hospital charges have steadily increased in the past two decades. Sepsis and malignancy were the two main determinants of unfavorable outcomes.