Mo1416 Outcomes of Post-ERCP Pancreatitis Have Not Improved Over the Past Decade

Abstract

statistically significant. Conclusions: Incidence of post-ERCP pancreatitis does not differ at academic institutions depending on the time of year. However, LOS and total hospital charge do decrease throughout the academic year, suggesting the existence of a temporal effect. These differences may be explained by the influx of new medical trainees, on whom teaching hospitals depend for the bulk of their staffing, and further investigation is warranted. Mo1416 Outcomes of Post-ERCP Pancreatitis Have Not Improved Over the Past Decade Allison R. Schulman*, Marwan Abou Gergi, Marvin Ryou, Christopher C. Thompson Division of Gastroenterology, Brigham & Women, Boston, MA; Catalyst Medical Consulting, Towson, MD Introduction: Pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). Over the past several years, routine use of rectally administered nonsteroidal anti-inflammatory drugs (NSAIDs) and prophylactic pancreatic stent placement in high risk patients have been utilized in an attempt to mitigate this complication. Aims: To compare outcomes of post-ERCP pancreatitis over the past decade (2002-2012) including overall incidence, mortality, intensive care unit (ICU) transfer rate, length of stay (LOS) and attributable total charge. Methods: The Nationwide Inpatient Sample (NIS) database was used to calculate outcomes in 2012, 2010, 2007, 2004 and 2002. Discharges with an ICD-9 CM procedure code indicating ERCP and a secondary ICD-9 CM code for acute pancreatitis were included. Patients were excluded if they had a principal diagnosis of acute pancreatitis or if the ERCP was performed before or on the day of admission. The primary outcome was incidence of post-ERCP pancreatitis. Secondary outcomes were in hospital mortality, ICU transfer rate, additional LOS and attributable total charge. All charges were adjusted for inflation using the consumer price index. Total disease burden was calculated by multiplying the total number of patients by the mean attributable total charge per hospitalization. LOS and charge were adjusted for the following potential confounders using a multivariable regression model: age, sex, race, median income in the patient’s zip code, number of comorbidities, hospital location (rural vs. urban), region (Northeast, Midwest, West, or South), teaching status, and size. Fisher’s exact test and Student t-test were used to compared proportions and continuous variables, respectively. Results: A total of 119,006 patients underwent inpatient ERCP in 2012, 2010, 2007, 2004, and 2002, 14,772 of whom developed post-ERCP pancreatitis leading to a cumulative incidence of 12.4%. Incidence of post-ERCP pancreatitis by year is shown in Table 1. The mortality rate, ICU transfer rate, and LOS do not show a particular trend over the past decade, and the disease burden ranges from over $7.6 million in 2004 to over $52.7 million in 2010 (Table 1). Conclusions: The incidence of post-ERCP pancreatitis appears to be increasing over the past decade, despite the routine use of NSAIDs and prophylactic pancreatic stent placement. The ICU transfer rate, LOS, and mortality have similarly not improved over this time period. Table 1. Post-ERCP pancreatitis outcome trends between 2002 and