Mo1425 Utilization Trends of Endoscopic Retrograde Cholangiopancreatography (ERCP) From 2000-2014 in a Large US Endoscopic Database

Abstract

patient tolerance of procedure, technical success, and recovery time, and most are limited to single centers with few patients. Our aim was to assess utilization of deep sedation with propofol among inpatients undergoing ERCP for choledocholithiasis and compare outcomes of mortality, complications, length of stay (LOS), and hospitalization cost between those who received deep sedation and those who did not. Methods: This cross-sectional study included hospitalized patients with a diagnosis of choledocholithiasis who underwent ERCP between 2006 and 2012. Data was obtained from the Perspective database, a validated dataset of inpatient admissions from O500 hospitals nationwide created to measure quality and health care utilization. Patient and hospital characteristics were compared by Chi-square and t-tests, and multivariable analysis was used to determine the effect of deep sedation on outcomes of in-hospital mortality, complications, LOS, and hospitalization cost. Results: We identified 60,342 eligible patients, of which 26,244 (43.5%) had deep sedation with propofol. The proportion of ERCP cases with propofol increased from 28.8% (2006) to 53.2% (2012). Mean age of the population was 63.8 20.1 years (62.3 with propofol, 65.1 without, p!0.0001). Patient characteristics inversely associated with propofol use were older age, Medicare insurance, and multiple comorbidities. Hospital characteristics inversely associated with propofol use were teaching status and larger hospital size. In-hospital mortality following ERCP was 1.2% (1.1% with propofol, 1.3% without, p!0.0001), rate of any complication was 38.2% (37.2% with propofol, 39.0% without, p!0.0001), LOS was 6.1 days (6.1 with propofol, 6.2 without, pZ0.13), and hospitalization cost was $13,127 7,463 ($13,414 with propofol, $12,905 without, p!0.0001). Adjusting for patient and hospital characteristics on multivariable analysis, hospitalization cost was $759 greater with propofol (p!0.0001) but there were no differences in in-hospital mortality (OR 0.97 95% CI 0.83-1.12), rate of any complication (OR 1.02 95% CI 0.991.06), and LOS (1.05 days more with propofol, 95% CI 0.96-1.14) between those who received propofol and those who did not. Conclusions: Utilization of propofol for ERCP in hospitalized patients with choledocholithiasis has increased. Selection of patients for deep sedation with propofol should be based on patient characteristics, irrespective of hospital characteristics and resources, as clinical outcomes are comparable and hospitalization cost differences are negligible.