Procedural time of day: A predictor of ERCP outcomes?

Abstract

Emerging data suggest time of day of endoscopic procedures may affect outcome due to endoscopist fatigue and decreased concentration. We therefore investigated whether afternoon endoscopic retrograde cholangiopancreatography (ERCP) adversely affects patient outcome. One thousand and six consecutive inpatient and outpatient ERCPs performed at the Mayo Clinic, Rochester from August 2010 to April 2011 were identified and the medical records were reviewed for demographic, clinical, and procedural data. The primary outcome was adverse event (AE) rate. The secondary outcome was procedural success rate. ERCP complexity was graded using published consensus guidelines. Univariate and multivariate analyses were performed to assess for predictors of and differences between am and pm ERCP outcomes. Of the 1006 ERCPs included, 512 (50.8%) were performed in the am and 494 (49.1%) in the pm. All ERCPs were performed with monitored anesthesia care. In univariate analysis, AE rates were not significantly different between am and pm ERCPs, 8.4% versus 8.7%, respectively (P = 0.85). Procedural success rates were also not significantly different between am and pm ERCPs, 96.1% versus 96.2%, respectively (P = 0.95). These differences remained nonsignificant for inpatient and outpatient ERCPs as well as in patients with surgically altered anatomy. By multivariate analysis, the time of day remained a nonsignificant predictor of AE and procedural success rates; performance of a sphincterotomy and individual endoscopist were found to impact AE rate. Based on this large, retrospective study, it appears there are no significant differences between am and pm ERCP AE rates and procedural success rates. Future studies should investigate the impact time of day has on endoscopic procedural outcomes in other practice settings, where scheduling practices, use of anesthesia support, endoscopist experience, and safeguards to minimize endoscopist fatigue may be different.