S1140 Gender and ERCP Complications: A Nationwide Inpatient Sample Database Analysis

Abstract

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) can involve a variety of complications including pancreatitis, hemorrhage, and cholangitis. Some studies have identified female gender as a risk factor for post-ERCP pancreatitis, cholangitis, and overall complications, however other studies have shown contradictory results. Given these discrepancies, we evaluated gender as a risk factor for post-ERCP complications using the National Inpatient Sample database. Methods: The National Inpatient Sample (NIS) database was used to identify hospitalized patients over 18 years old who had an ERCP procedure between 2007 - 2017 using ICD-9 and ICD-10 codes. Patients were divided into two groups: males (726,352 [40.1%]) or females (1,084,048 [59.9%]), as defined by NIS as “indicator of sex”. Patients were matched by age, race, and by Elixhauser comorbidity index. Primary outcomes were rates of post-ERCP pancreatitis, cholangitis, cholecystitis, infection, hemorrhage, and perforation. Chi-squared tests were used to compare categorical data and multivariate analyses were performed to assess primary outcomes. Results: There were 1,810,400 patients hospitalized from 2007-2017 who underwent an ERCP procedure, of which 1,084,048 (59.9%) were female and 726,352 (40.1%) were male. Primary outcomes were significant for increased odds ratio of post-ERCP pancreatitis (OR 1.2, p< 0.001) and decreased odds ratio of post-ERCP cholangitis (OR 0.7, p< 0.001), cholecystitis (OR 0.4, p< 0.001), infection (OR 0.7, p< 0.001), and hemorrhage (OR 0.6, p< 0.001) in females compared to males. No significant difference was found between men and women for post-ERCP perforation. Conclusion: Although there are differences in the effects of gender on post-ERCP complications in the literature, the mechanisms causing these effects are not known. Women are known to have higher risks for biliary stones and sphincter of Oddi dysfunction which can further increase the odds of post-ERCP pancreatitis. We postulate that the decreased rates of cholangitis, cholecystitis, infection, and hemorrhage in women compared to men could be from an anatomical variation in the biliary tree that is gender specific. Therefore, endoscopists should further explore and consider this possibility when performing ERCPs. Table 1. - Clinical Outcomes in Females and Males who underwent ERCP p value Odds Ratio Confidence Interval Post-ERCP Pancreatitis < 0.001 1.2 1.1-1.3 Post-ERCP Cholangitis < 0.001 0.7 0.7-0.8 Post-ERCP Cholecystitis < 0.001 0.4 0.4-0.5 Post-ERCP Infection < 0.001 0.7 0.7-0.7 Post-ERCP Hemorrhage < 0.001 0.6 0.5-0.7 Post-ERCP Perforation 0.304 1.1 1.0-1.2