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Sunday Poster Session

Category: Interventional Endoscopy

P0854 - Clinical Outcomes and Predictors of 30-Day Readmissions of Endoscopic Retrograde Cholangiopancreatography in the United States

Sunday, October 22, 2023
3:30 PM – 7:00 PM PT
Location: Exhibit Hall
Dushyant Singh. Dahiya, MD1, Bhanu Siva Mohan Pinnam, MD2, Saurabh Chandan, MD3, Manesh Kumar Gangwani, MD4, Hassam Ali, MD5, Daksh Ahluwalia, MD2, Harishankar Gopakumar, MD6, Muhammad Aziz, MD4, Chun-Wei Pan, MD2, Jay Bapaye, MBBS, MD7, Mohammad Al-Haddad, MD8, Neil Sharma, MD9
1University of Kansas School of Medicine, Kansas City, KS; 2John H. Stroger, Jr. Hospital of Cook County, Chicago, IL; 3Creighton University School of Medicine, Omaha, NE; 4University of Toledo, Toledo, OH; 5ECU Health Medical Center / Brody School of Medicine, Greenville, NC; 6University of Illinois, Peoria, IL; 7Rochester General Hospital, Rochester, NY; 8Indiana University, Indianapolis, IN; 9Parkview Health, Fort Wayne, IN

Introduction: Since its inception in 1968, there has been an exponential rise in the utilization of endoscopic retrograde cholangiopancreatography (ERCP) for the management of numerous pancreaticobiliary disorders. The 30-day readmission rate is an important healthcare quality metric that affects hospital reimbursements and reflects patient care quality. A knowledge gap exists in our understanding of factors influencing early readmissions following ERCP. This study was designed to investigate clinical outcomes and predictors for 30-day readmission of ERCP in the United States.

Methods: The National Readmission Database was utilized from 2016–2020 to identify all adult (≥18 years old) hospitalizations that underwent ERCP during the index hospitalization. All-cause readmissions within 30 days were identified. Multivariate regression analysis was used to assess the odds of all-cause 30-day readmission and to compare inpatient mortality, mean length of stay (LOS), and mean total hospital charges (THC) between the index and 30-day readmissions of ERCP after adjusting for potential confounders. Predictors of 30-day readmissions of ERCP were also identified.

Results: Between 2016–2020, 885,416 index hospitalizations underwent ERCP. Of these, 88,380 (10.15%) were readmitted within 30 days. Compared to index hospitalizations, 30-day readmissions had a higher mean age (63.76 vs. 60.8 years, p< 0.001), and proportion of patients with Charlson Comorbidity Index (CCI) score ≥3 (48.26% vs. 29.91%, p< 0.001). Sepsis was the most common readmission diagnosis. Higher age, male gender, higher CCI score, and admission at large metropolitan teaching hospitals were independent predictors of 30-day readmissions. Compared to index hospitalizations, 30-day readmissions had higher odds of inpatient mortality (4.42% vs. 1.66%, aOR 1.9, 95% CI:1.79-2.01, p< 0.001) [Table 1]. However, 30-day readmissions of ERCP had a shorter length of stay (5.78 vs. 6.22 days, Mean Difference [MD] 1.2, 95% CI: 1.12-1.28, p< 0.001) and lower total hospital charge ($71,076 vs. $93,418, [MD] $31,452, 95% CI: 29,835-33,069, p< 0.001) compared to index admissions.

Discussion: ERCP on index admission was associated with a 10.15% readmission rate within 30 days. Implementing knowledge of factors associated with higher readmission rates in clinical decision-making may help identify high-risk individuals and tailor care to reduce the risk of readmission and the overall healthcare burden.
Independent predictors for 30-day readmissions of endoscopic retrograde cholangiopancreatography in the United States from 2016–2020
VariableAdjusted Odds Ratio 95% Confidence Interval P-value
Gender
FemaleReferent
Male1.18 1.15-1.20 < 0.001
Age Groups   
 18 - 34  Referent  
 35 - 49  1.43   1.36-1.50   < 0.001
 50 - 64   1.56 1.48-1.63   < 0.001
 65 - 79  1.33  1.26-1.41   < 0.001
 ≥80  1.2  1.13-1.27   < 0.001
Charlson Comorbidity Index (CCI)
CCI (with an increase of one point)  1.15   1.15-1.16   < 0.001
Hospital Bed Size
Small    Referent
Medium  1.09 1.04-1.14   < 0.001
Large 1.2  1.15-1.25   < 0.001
Hospital Location and Teaching Status
Metropolitan non-teaching Referent
Metropolitan teaching   1.12  1.08-1.15   < 0.001
Non-metropolitan  0.83  0.69-1.00   0.059
    Comparative analysis of inpatient mortality and healthcare burden for index hospitalizations and 30-day readmissions of endoscopic retrograde cholangiopancreatography in the United States from 2016–2020
VariableIndex admission vs 30-day readmissionsAdjusted Odds Ratio (95% confidence
interval)		P-value
Overall14693(1.66%) vs 3907(4.42%)1.9 (1.79-2.01)< 0.001
 Age Group   
 18 - 34 220(0.19%) vs 37(0.6%)1.23 ( 0.69-2.2) 0.472
 35 - 49 705(0.57%) vs 237(2.21%)2.08 ( 1.6-2.7) < 0.001
 50 - 64 3132(1.43%) vs 1084(4.49%)2.15 ( 1.89-2.4) < 0.001
 65 - 79 6264(2.31%) vs 1567(5.08%)1.66 ( 1.51-1.82) < 0.001
 ≥80 4371(2.78%) vs 980(6.02%)1.93 ( 1.74-2.14) < 0.001
 Gender   
 Male 8205(2.1%) vs 2113(4.78%)1.76 ( 1.62-1.90) < 0.001
 Female 6487(1.3%) vs 1794(4.06%)2.08 ( 1.92-2.25) < 0.001
 Charlson Comorbidity Index (CCI)   
 CCI=0 709(0.22%) vs 152(0.84%)3.09 ( 2.32-4.10) < 0.001
 CCI=1 1148(0.63%) vs 221(1.61%)2.46 ( 1.97-3.05) < 0.001
 CCI=2 1665(1.41%) vs 449(3.25%)2.37 ( 2.03-2.7) < 0.001
 CCI≥3 11168(4.22%) vs 3084(7.23%)1.75 ( 1.64-1.8) < 0.001
 Healthcare burden    
 Variable Index Admissions vs 30-Day ReadmissionsMean Difference (95% Confidence interval) P-value
 Total Hospital Charges ($) 93418 vs 7107631452 (29835-33069) < 0.001
 Length of Stay (days) 6.22 vs 5.781.2 (1.12-1.28) < 0.001

Table: Part 1: Independent predictors for 30-day readmissions of endoscopic retrograde cholangiopancreatography in the United States from 2016–2020.
Part 2: Comparative analysis of inpatient mortality and healthcare burden for index hospitalizations and 30-day readmissions of endoscopic retrograde cholangiopancreatography in the United States from 2016–2020


Disclosures:
Dushyant Dahiya indicated no relevant financial relationships.
Bhanu Siva Mohan Pinnam indicated no relevant financial relationships.
Saurabh Chandan indicated no relevant financial relationships.
Manesh Kumar Gangwani indicated no relevant financial relationships.
Hassam Ali indicated no relevant financial relationships.
Daksh Ahluwalia indicated no relevant financial relationships.
Harishankar Gopakumar indicated no relevant financial relationships.
Muhammad Aziz indicated no relevant financial relationships.
Chun-Wei Pan indicated no relevant financial relationships.
Jay Bapaye indicated no relevant financial relationships.
Mohammad Al-Haddad: Amplified Sciences – Grant/Research Support. Creatics, LLC – Grant/Research Support. Interpace diagnostics – Consultant.
Neil Sharma: Boston Scientific – Consultant. Mauna Kea – Consultant. Medtronic – Consultant. Olympus – Consultant. Steria – Consultant.


Dushyant Singh. Dahiya, MD1, Bhanu Siva Mohan Pinnam, MD2, Saurabh Chandan, MD3, Manesh Kumar Gangwani, MD4, Hassam Ali, MD5, Daksh Ahluwalia, MD2, Harishankar Gopakumar, MD6, Muhammad Aziz, MD4, Chun-Wei Pan, MD2, Jay Bapaye, MBBS, MD7, Mohammad Al-Haddad, MD8, Neil Sharma, MD9. P0854 - Clinical Outcomes and Predictors of 30-Day Readmissions of Endoscopic Retrograde Cholangiopancreatography in the United States, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.