Tu1417 DO HISPANICS HAVE HIGHER OCCURRENCE OF POST-ERCP PANCREATITIS?

Abstract

Post–endoscopic retrograde cholangiopancreatography (ERCP) acute pancreatitis (PEP) remains the most common major adverse event after ERCP. Reported rates range from 5% to 10% in low-risk subjects, to 30% in higher risk patients. Ethnicity has not been well studied before. Therefore, the aim of this study was to assess the occurrence of PEP in Hispanics compared to other ethnicities using a national database. Case-control study using the National Inpatient Sample 2014, the largest publically available inpatient database in the United States. All patients with ICD-9 CM codes corresponding to PEP were included. There were no exclusion criteria. Hispanic patients were identified from the ethnic categories within the database. The primary outcome was determining the odds of PEP in Hispanics when compared to other ethnicities. Secondary outcomes were inpatient mortality, morbidity, as measured by shock, ICU stay and multi-organ failure; resource utilization, measured by use of abdominal CT scan and abdominal US; length of hospital stay (LOS), total hospitalization charges and costs. Propensity score matching was used to create a 1:1 matching population, regressed against gender, age and Charlson Comorbidity Index. Multivariate regression analyses were used to further adjust for income in patients’ zip code, hospital region, location, size and teaching status. A total of 7,615 cases of PEP were identified, of which 2,285 matched pairs were included. 1,520 (67%) were Hispanic . The mean patient age was 51 years and 66% were female. The prevalence of PEP was increased in Hispanics (37.6/100,000 admissions) when compared to non-Hispanics (19.5/100,000 admissions). After adjusting for confounders using multivariate analysis, Hispanics displayed adjusted matched odds of 1.95 (95%CI:1.54-2.48, p<0.01) of having PEP when compared to all other ethnicities. All outcomes are displayed in Table 1. For secondary outcomes, Hispanics displayed higher matched odds of multi-organ failure (OR: 2.18, 95%CI:1.03-4.62, p=0.04) but similar adjusted matched odds of mortality, shock, ICU stay, TPN use, CT Abdomen, abdominal ultrasound when compared to other ethnicities. For resource utilization, Hispanics admitted with PEP displayed higher additional total hospitalization charges but similar adjusted additional hospital costs and LOS when compared to other ethnicities. Hispanic patients have associated higher occurrence and odds of PEP when compared to all other ethnicities, potentially due to the higher obesity prevalence, higher incidence of biliary pancreatitis and hence increased ERCP use in Hispanics. Interestingly, although hospital costs did not differ among ethnic groups, total hospital charges were increased in the Hispanics, potentially suggesting a disparity in terms of insurance policy or model.Tabled 1TABLE 1HispanicsNon-Hispanicsp-valueInpatient Prevalence (per 100,000 admissions)37.619.5<0.01VariableAdjusted Odds Ratio95% CIp-valueAdditional Hospital Costs$5,223-$893 – $11,3380.09Additional Hospital Charges$33,347$2,213 – $64,5810.04Additional Length of Stay (days)1.38-0.52 – 3.300.15VariableAdjusted Odds Ratio95% CIp-valuePost ERCP Pancreatitis1.951.54-2.48<0.01Mortality0.200.01-19.600.50Shock2.510.70-9.020.16ICU3.780.91-15.790.07TPN1.020.26-4.010.97CT Abdomen1.470.13-16.170.75Abdominal Ultrasound1.660.56-4.930.36Multi-Organ Failure2.181.03-4.620.04 Open table in a new tab