Hospitalization and In-Hospital Mortality of Cholangitis in the Advent of Therapeutic Biliary ERCP

Abstract

Background: The severity of cholangitis can range from mild to fatal. In recent years there has been increasing recognition of cholangitis and increasing utilization of endoscopic biliary drainage procedures. The purpose of this study was to determine national trends in the hospitalization and in-hospital mortality of cholangitis in the advent of the utilization of therapeutic biliary ERCP. Methods: The Nationwide Inpatient Sample database was utilized to determine the age-adjusted hospitalization rate and in-hospital mortality of cholangitis (ICD-9-CM 576.1) for each year between 1988 and 2004. Age-adjusted procedure rates for biliary stent placement and sphincterotomy were also analyzed. Results: The Nationwide Inpatient Sample database contained 115,518 patients who were diagnosed with cholangitis. The mean age of the patients was 65.47 ± 17.87 years old and was composed of 49.9% males and 50.1% females. The age-adjusted hospitalization rate of cholangitis increased 18% from 6.5 per 100,000 in 1988 to 7.7 per 100,000 in 1997 (P<0.01). The age-adjusted hospitalization rate then declined slightly and stabilized at 7.6 per 100,000 in 2004. The age-adjusted hospitalization rate increased steadily in males from 1988 to 2004 (59.8%). Hospitalization rates were highest among Asian/Pacific Islanders (18.4 per 100,000) followed by Hispanic Americans (10.9 per 100,000) and was lowest in African Americans (5.7 per 100,000). In-hospital mortality data from 1988-2004 included 6,174 patients. The mean age of the patients was 72.19 ± 15.28 years old and was composed of 51.6% males and 48.5% females. The age-adjusted in-hospital mortality of cholangitis was 2.2 per 1,000 in the 1988-1992 time period which peaked at 2.9 per 1,000 in the period 1993-1996 (P < 0.01). The mortality rate declined to 2.4 per 1,000 in the 1997-2000 (P < 0.01) time period and stabilized to 2.5 per 1,000 in 2001-2004. The age-adjusted procedure rates for ERCP with biliary stenting increased from 5.4 per 100,000 in 1989 to 113.8 per 100,000 in 2002 (increase by 150%) (P<0.01). The age-adjusted procedure rates for ERCP with sphincterotomy also increased from 10.6 per 100,000 in 1989 to 315.8 per 100,000 in 2002. Conclusions: The overall trend in the hospitalization of cholangitis has been increasing over the last two decades, particularly in male patients. Hospitalization rates were highest among Asian/Pacific Islanders and lowest among African Americans. The overall trend in mortality peaked between 1993 and 1996 with a subsequent decline that is most likely secondary to the widespread utilization of therapeutic biliary endoscopy.