S0916 Analysis of Clinical Outcomes and Length of Stay Among Patients With Systemic Lupus Erythematosus Undergoing Endoscopic Retrograde Cholangiopancreatography: A Nationwide Inpatient Sample Analysis

Abstract

INTRODUCTION: Systemic Lupus Erythematosus (SLE) is a chronic disease that is characterized by a high inflammatory state and is associated with biliary and pancreatic disease. Endoscopic Retrograde Cholangiopancreatography (ERCP) is the standard of care for diagnosing and treating biliary or pancreatic ductal complications. The literature is deficient on the associations of ERCP related outcomes and complications in SLE patients. This study aims to evaluate the effects of SLE on clinical outcomes and in-patient mortality in patients undergoing ERCP. METHODS: The NIS database was used to identify hospitalized patients who had an ERCP study from 2012 to 2014 using ICD-9 codes. Patients were divided into 2 groups, those with and without SLE. Primary outcomes: mortality, hospital charges, and length of stay (LOS). Secondary outcomes: ERCP related complications (perforation, pancreatitis, gastrointestinal (GI) bleed, fistula/abscess formation, and sepsis). Chi squared tests for categorical data and independent T test for continuous data were used to compare the outcomes between the 2 groups. Multivariate analysis was done to assess the primary outcomes after adjusting for confounding variables. RESULTS: There was 83,900 ERCP related hospitalizations from 2012 to 2014, of which 420 patients had SLE. In patients with SLE who had an ERCP procedure, 390 (92.9%) were female and the average age was 53.1. The average LOS was 7.7 days, mortality rate was 2.4% (10 patients), and total hospital charges was $71,758. There was no statistical significance in the primary outcomes of LOS, mortality, or hospital cost in SLE patients. There was no statistical significance in the rate of pancreatitis, GI bleed, perforation, abscess formation, or sepsis. In SLE patients, there were statistically significant less strictures (20.2% vs 24.9%, OR 0.87, 95% CI 0.68–1.11) and higher fistula formation rates (1.2% vs 0.2%, OR 7.60, 95% CI 3.05–18.9). CONCLUSION: With SLE patients being in a high inflammatory state, it was hypothesized that SLE would be associated with higher rates of complications after ERCP procedures leading to prolonged hospitalization and worse outcomes. However, in this study, the primary outcomes were not found to be statistically significant, but an increased risk of fistula formation was significant. It is possible that many SLE patients do not present with an acute flare and are likely immunosuppressed which can have a protective effect on the results. Further studies are needed to elucidate such associations.Table 1.: Table demonstrating demographics and resource utilization of patients with and without Lupus who had an endoscopic retrograde cholangiopancreatography procedureTable 2.: Table demonstrating clinical outcomes in patients with and without Lupus, who underwent endoscopic retrograde cholangiopancreatography procedures during their hospitalization