Similar Morbidity and Mortality for ERCPs Performed Over the Weekend versus Postponing to Next Available Weekday

Abstract

Introduction: Weekend (WE) effect is a phenomenon used to described worse outcomes when patients are cared for on the WE versus the weekday (WD). Prior research studying the WE effect on endoscopic retrograde cholangiopancreatography (ERCP) have had variable results. Preforming an ERCP requires significant resources which are frequently unavailable over the WE, leading to postponement. Currently little is known about the consequences of postponing an ERCP. We aimed to further elucidate the morbidity and mortality risks conferred to the patient by postponing ERCP to the next available WD. Methods: Patients (p) from 1/2011-12/2016 were queried from the electronic medical record. Adults who had a gastroenterology evaluation on Friday or Saturday which resulted in an ERCP being performed on the WE, Saturday or Sunday, versus being postponed to the first available WD, Monday or Tuesday were included. The primary outcomes were mortality and morbidity. Morbidity was defined as post-ERCP pancreatitis (lipase>3xULN), NSTEMI (troponin>0.05), AKI (increase in creatinine>50% of the highest pre-ERCP value), and acute anemia (decease in hemoglobin>20% of the highest pre-ERCP value). Escalation of care post ERCP, (transfer from regular medical floor to ICU), disposition at discharge, 30-day readmission, and repeat ERCP within 30 days was also assessed. All categorical and continuous variables were analyzed with Pearson chi-squared/Fisher exact test and Mann-Whitney U tests respectively. Results: Among 5,196 patients undergoing ERCPs, 533 patients were identified, including 218 (41%) patients in the WD group and 315 (59%) patients in the WE group. Both groups have clinically similar baseline characteristics (Table 1) except for pre-ERCP vitals, with patient generally sicker 24 hours prior to procedure in the WD group. In-hospital mortality was 1p (0.5%) in the WD group and 2p (0.6%) in the WE group (p=1.00). Post-ERCP morbidity including elevated lipase, myocardial infarction, acute kidney injury, and acute anemia were similar in both groups. Post-procedural vitals, need for a progressive or ICU level of care, the need to escalate care, disposition at discharge, and need for repeat ERCP was similar in both group (p>0.05). Thirty-day readmission was 51p (23.4%) in the WD group vs 52p (16.5%) in the WE group (p=0.05). (Table 2) Conclusion: There are similar rates of morbidity and mortality performing ERCPs on the weekend when compared to postponing to the next available weekday.