National Trend in Post-Endoscopic Retrograde Cholangiopancreatography (ERCP) Pancreatitis in United States: Analysis of the Nationwide Inpatient Sample (NIS) Database, 2004-2014

Abstract

Introduction: Post-ERCP pancreatitis (PEP) is the most common complication following ERCP with an estimated annual cost burden in excess of $200 million. In recent years, there have been many advances in preventive strategies, including administration of rectal indomethacin to reduce the incidence of PEP. We report population-based trends over a 10-year period in the incidence of PEP in the United States. Methods: The NIS database was queried to identify patients who had an ERCP with or without PEP from 2004 to 2014. We adopted the previously validated definition for PEP from the NIS database. Appropriate International Classification of Diseases, 9th Revision (ICD-9) diagnosis codes were used to isolate PEP cases. The primary outcome was PEP and secondary outcomes were in-hospital death, length of stay and hospital costs. Poisson regression models were used to derive adjusted incidence risk ratios (IRR) of PEP and outcomes over time. Independent predictors of mortality and extended length of stay were determined by multivariate logistic regression. Results: Of 381,288 discharges (60.8% females) for patients who underwent ERCP, we found a total of 37,712 discharges for PEP (9.9%). Among the all the patients, 198,269 (52.0%) were performed in teaching hospitals. The median age was 60 (IQR 46-75) years. The number of in-patient ERCPs performed was 32,346 in 2004, with a peak of 38,394 in 2011, and decreased to 34,730 in 2014. From 2004 to 2014, the rate of PEP increased by 23.6 % (8.9% to 11.0%, p-trendTable 1 summarizes the results of the multivariable analysis.Table: Table. Multivariable Logistic Regression Analysis of predictors of post-ERCP pancreatitisConclusion: Over the past decade, there has been a considerable increase in the incidence of PEP in the US despite a simultaneous decrease in number of ERCPs performed. This trend is likely to continue in the near future and suggest a need for a better understanding of pathogenesis and preventive strategies for PEPFigure: Proportion of discharges with post-ERCP pancreatitis.Figure: Number of ERCPs performed.Figure: Mortality, length of stay and cost.