Intestinal perforations after endoscopic retrograde cholangiopancreatography in the United States: a 16-year study using the national inpatient sample

Abstract

Background Intestinal perforation is a rare but feared complication of ERCP. In this study, we identify patient and hospital factors for ERCP related intestinal perforation using a large national database. We also examine the effects of intestinal perforations on hospital outcomes. Methods Data were obtained from the National Inpatient Sample, the largest publicly available inpatient care database in the United States. ICD-9-CM procedure codes for all ERCP procedures conducted between 1998 and 2013. Our primary outcome of interest was the incidence of intestinal perforations after ERCP. Secondary outcomes of interest included hospital length of stay and inpatient mortality. Results A total of 392,336 ERCP procedures were performed over the study period, met our inclusion criteria, and were analyzed. Mean age of sample was 59 years and just over 60% were females. Low volume hospitals accounted for over 85% of ERCPs. Intestinal perforations occurred at a rate of 1.2 per 1000 ERCP procedures. Patient's age was the only patient-related factor significantly associated with perforation. (OR: 1.016; 95% CI 1.009 - 1.025). For hospitals, teaching status was the only hospital related factor associated with intestinal perforation after ERCP (OR: 1.56; 95% CI 1.28 -1.91). Length of stay was much longer in patients with ERCP related perforations and mortality risk was ten times higher in the same cohort. Conclusions Patients who have ERCP related perforations have longer hospital stays and have a higher mortality risk. Older patients and those who had ERCP in teaching hospitals are at a higher risk of perforation.