P0016 - Endoscopic Retrograde Cholangiopancreatography in the Elderly: Trends, Demographic Variations, Complications, and Outcomes

Ammar Qureshi, MD¹, Dhanshree Solanki, MHA², Khwaja F. Haq, MD³, Amie Patel, DO⁴, Uvesh Mansuri, MD, MPH⁵, Shantanu Solanki, MD, MPH⁶, Khwaja Saad Haq, MD⁷, Ratna Joshi, MD⁸, Asim Kichloo, MD⁹, Jagmeet Singh, MD¹⁰, Zarak Hassan Khan, MD¹¹, Mohammed Asad Chishti, MBBS¹², Syed-Mohammed Jafri, MD^13
1Eisenhower Health, Rancho Mirage, CA; ²Rutgers University, New Brunswick, NJ; ³Stony Brook University Hospital, Stony Brook, NY; ⁴New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY; ⁵MedStar Good Samaritan Hospital/ Critical Care Medicine, Towson, MD; ⁶Geisinger Commonwealth School of Medicine, Sayre, PA; ⁷Kingsbrook Jewish Medical Center, Brooklyn, NY; ⁸Guthrie Robert Packer Hospital, Sayre, PA; ⁹Central Michigan University College of Medicine, Saginaw, MI; ¹⁰Guthrie/Robert Packer Hospital, Sayre, PA; ¹¹St. Mary Mercy Hospital, Livonia, MI; ¹²The Royal College of Surgeons in Ireland – Medical University of Bahrain, Busaiteen, Al Muharraq, Bahrain; ¹³Henry Ford Health System, Detroit, MI

Introduction: With increasing life expectancy, a higher number of elderly patients are undergoing endoscopic retrograde cholangiopancreatography (ERCP). Adverse events in the general population from ERCP range from 5%-10% and mortality rates range from 0.3% to 0.5%. While epidemiological data and complication rates of ERCP in the general population have been well studied, limited data exists with respect to the elderly population.



Methods: We analyzed the national inpatient sample (NIS) database for all hospitalized patients who had undergone an ERCP from 2005 to 2014. We then utilized the Cochran-Armitage trend test and multivariate survey logistic regression to analyze trends, demographic variations, predictors, and outcomes.

Results: We compared 647,818 patients older than 65 years to 792,825 patients younger than 65 years. Amongst elderly patients who had undergone an ERCP, the number of hospitalizations increased from 53,972 in 2005 to 74,940 in 2014. Similar trend was seen in patients younger than 65 years (Figure 1). The mean age of patients above 65 years was 77.5 years, out of which 44.7% were male and 55.3% were female (Table 1). The mean length of stay was 7.48 days in patients above 65 years but only 6.24 days in patients younger than 65 years. A lesser number of elderly patients had an emergent ERCP than younger patients (22.8% vs 23.2%; p< 0.0001) (Table 1). Post-ERCP pancreatitis was higher in younger patients than elderly patients (6.14% vs 9.44%; p< 0.0001) (Table 1). Perforation rates were higher in the elderly patients (0.17% vs 0.12%; p< 0.0001) and more elderly patients had ERCP related hemorrhage when compared to younger patients (1.44% vs 1.07; p< 0.0001) (Table 1). Also, the rate of post-ERCP cholecystitis was higher in elderly patients (2.25% vs 2.23%; p< 0.0001). Majority of the elderly patients were discharged home (76.9%), but the all-cause mortality rate was higher in elderly patients undergoing ERCP than younger patients (2.5% vs 0.9%; p< 0.0001) (Table 1).

Discussion: Our analysis showed that the hospitalization rate of elderly patients undergoing an ERCP increased from 2005 to 2014. Elderly patients undergoing ERCP had a longer mean length of stay and all-cause mortality than younger patients. Moreover, except post-ERCP pancreatitis, elderly patients had significantly higher rates of ERCP-related complications than younger patients.


Figure: Trends in hospitalizations with ERCP

Characteristics		Age < 65 (n = 792,825)	Age >=65 (n = 647,818)	P-value
Mean age (years ± SE)		44.6 ± 0.1	77.5 ± 0.1
Gender (%)				< 0.0001
	Male	35.1	44.7
	Female	64.9	55.3
Race (%)
	White	61.2	76.6
	Black	10.9	6.2
	Hispanic	6.2	9.8
	Other	7.5	7.3
Hospital bed size (%)				< 0.0001
	Small	10.2	10.2
	Medium	24.5	25.3
	Large	65.3	64.6
Hospital region (%)				< 0.0001
	Northeast	20.3	24.9
	Midwest	17.0	17.5
	South	37.0	35.2
	West	25.6	22.4
Hospital type (%)				< 0.0001
	Rural	4.7	5.6
	Urban Non-teaching	40.1	44.2
	Teaching	55.2	50.2
Primary insurance (%)				< 0.0001
	Medicare/Medicaid	30.9	90.6
	Private including HMO	51.6	7.8
	Uninsured/ Self Pay	17.4	1.6
Type of admission (%)				< 0.0001
	Elective	76.8	77.2
	Emergent or Urgent	23.2	22.8
Disposition status (%)				< 0.0001
	Home	94.5	76.9
	Facility	4.6	20.6
	Died	0.9	2.5
Mean LOS (days ± SE)		6.24 ± 0.05	7.48 ± 0.04
Complications of ERCP
	Post-ERCP Pancreatitis	9.44	6.14	< 0.0001
	Perforation	0.12	0.17	< 0.0001
	Cholecystitis	2.23	2.25	< 0.0001
	ERCP-associated Hemorrhage	1.07	1.44	< 0.0001

Table: Baseline characteristics and complications of ERCP of study population


Disclosures:
Ammar Qureshi indicated no relevant financial relationships.
Dhanshree Solanki indicated no relevant financial relationships.
Khwaja Haq indicated no relevant financial relationships.
Amie Patel indicated no relevant financial relationships.
Uvesh Mansuri indicated no relevant financial relationships.
Shantanu Solanki indicated no relevant financial relationships.
Khwaja Saad Haq indicated no relevant financial relationships.
Ratna Joshi indicated no relevant financial relationships.
Asim Kichloo indicated no relevant financial relationships.
Jagmeet Singh indicated no relevant financial relationships.
Zarak Hassan Khan indicated no relevant financial relationships.
Mohammed Asad Chishti indicated no relevant financial relationships.
Syed-Mohammed Jafri indicated no relevant financial relationships.


Ammar Qureshi, MD¹, Dhanshree Solanki, MHA², Khwaja F. Haq, MD³, Amie Patel, DO⁴, Uvesh Mansuri, MD, MPH⁵, Shantanu Solanki, MD, MPH⁶, Khwaja Saad Haq, MD⁷, Ratna Joshi, MD⁸, Asim Kichloo, MD⁹, Jagmeet Singh, MD¹⁰, Zarak Hassan Khan, MD¹¹, Mohammed Asad Chishti, MBBS¹², Syed-Mohammed Jafri, MD¹³. P0016 - Endoscopic Retrograde Cholangiopancreatography in the Elderly: Trends, Demographic Variations, Complications, and Outcomes, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.