Obesity and Post ERCP Complications Among Hospitalized Patients with Cholangitis

Abstract

Introduction: Complications of Endoscopic Retrograde Cholangiopancreatography (ERCP) are an important concern, especially in cholangitis patients. Relationship between obesity and complications of ERCP remain unknown. We sought to evaluate the relationship between obesity and post ERCP complications in hospitalized cholangitis patients. Methods: We analyzed National Inpatient Sample (NIS) database from 2001 to 2010 and identified adult inpatients (> 18 years) with a principal diagnosis of cholangitis using International Classification of Disease 9th Revision, Clinical Modification (ICD9-CM) codes 576.1. Obese patients were identified using ICD9-CM code 278.0. The primary outcomes included rates of post ERCP complications (pancreatitis, cholecystitis, perforation, pulmonary complications) and secondary outcome was mortality. We compared the complication rates among patients with and without obesity, using chi square and student t test. Multivariable logistic regression adjusting for patient demographics such as age, sex, income, hospital diagnosis, co morbidities, hospital characteristics (bed size, hospital location, rural/urban, teaching vs non teaching) and case mix was used to investigate the odds of various ERCP related complication for obese patients compared to non obese patients. Results: Our final sample comprised 38,557 patients. Of these, 1281 (3.3%) were obese and 37,276 (96.7%) were non obese. When compared with non-obese patients, obese individuals had similar rates of post ERCP pancreatitis (1.3% vs 0.9%, p = 0.18), perforation (0.08% vs 0.1%, p = 0.71), cholecystitis (0.6% vs 0.5%, p = 0.68) and pulmonary complications (1.8% vs 2.2%, p = 0.29). However, mortality was reduced among obese (1% vs 3%, p < 0.01) when compared to non-obese patients. Conclusion: Among the inpatients undergoing ERCP for cholangitis, there were no differences in post ERCP complications by obesity. However, obese patients had less in-patient mortality for reasons that are unclear. Further studies are needed to elucidate effect of obesity on ERCP outcomes.