S1148 A National Inpatient Sample Analysis of Paralytic Ileus and ERCP Complications

Abstract

Introduction: Paralytic ileus is often seen in critically ill, hospitalized patients. Patients with pancreaticobiliary diseases require endoscopic retrograde cholangiopancreatography (ERCP) for diagnosis and treatment. ERCP can lead to multiple post-procedural complications, which can worsen the morbidity and mortality of patients. The associations between paralytic ileus and post-ERCP complications have not been explored previously. Methods: The National Inpatient Sample 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: those with and without paralytic ileus. Primary outcomes were mortality, length of stay, payor status, and total charges. Secondary outcomes were rates of post-ERCP pancreatitis, cholangitis, cholecystitis, infection, hemorrhage, and perforation. Patients were matched by age, race, sex, and Elixhauser comorbidity index. Chi-squared tests compared categorical data, independent t-tests compared continuous data, and multivariate analyses assessed secondary outcomes. Results: Of the 87,502 patients who met the inclusion criteria, 43,859 had paralytic ileus. There were no differences in age or race between the two groups, but those with paralytic ileus had an increased length of stay, higher total charges, more patients on Medicaid or Medicare, and mortality compared to the control group (p< 0.001). The data was also significant (p< 0.001) for an increased odds ratio for post-ERCP pancreatitis (OR 5.6), perforation (OR 14.6), cholangitis (OR 15.3), cholecystitis (OR 7.4), infection (OR 10.4), hemorrhage (OR 15.2), and mortality (OR 2.1). Conclusion: Paralytic ileus is commonly seen in hospitalized patients with up to 6% mortality. Ileus is usually caused by dysregulation of sympathetic and parasympathetic control affecting the gut. This condition usually occurs secondary to medications, metabolic derangements, and surgical interventions. Their clinical status puts them at higher risks for multiple post-procedural compilations. Therefore, patients with paralytic ileus should be medically optimized before undergoing ERCP. (Table) Table 1. - Clinical Outcomes in Patients With and Without Paralytic Ileus who Underwent Endoscopic Retrograde Cholangiopancreatography (ERCP) Odds Ratio (95% CI) P-Value Post-ERCP Pancreatitis 5.6 (4.6-6.7) < 0.001 Post-ERCP Perforation 14.6 (9.3-23.0) < 0.001 Post-ERCP Cholangitis 15.3 (11.9-19.6) < 0.001 Post-ERCP Cholecystitis 7.4 (4.3-12.6) < 0.001 Post-ERCP Infection 10.4 (8.9-12.2) < 0.001 Post-ERCP Hemorrhage 15.2 (9.0-25.8) < 0.001 Mortality 2.1 (1.9-2.2) < 0.001 CI = Confidence Interval.