Utilization trends in inpatient endoscopic retrograde cholangiopancreatography (ERCP): A cross-sectional US experience

Abstract

Study aims The goal of our study was to determine the current trends for inpatient utilization for endoscopic retrograde cholangiopancreatography (ERCP) and its economic impact in the United States between 2002 and 2013.

Patients and methods A Nationwide Inpatient Sample from 2002 through 2013 was examined. We identified ERCPs using International Classification of Diseases (ICD-9) codes; Procedure codes 51.10, 51.11, 52.13, 51.14, 51.15, 52.14 and 52.92 for diagnostic and 51.84, 51.86, 52.97 were studied. Rate of inpatient ERCP was calculated. The trends for therapeutic ERCPs were compared to the diagnostic ones. We analyzed patient and hospital characteristics, length of hospital stay, and cost of care after adjusting for weighted samples. We used the Cochran-Armitage test for categorical variables and linear regression for continuous variables.

Results A total of 411,409 ERCPs were performed from 2002 to 2013. The mean age was 59 ± 19 years; 61 % were female and 57 % were white. The total numbers of ERCPS increased by 12 % from 2002 to 2011, which was followed by a 10 % decrease in the number of ERCPs between 2011 and 2013.

There was a significant increase in therapeutic ERCPs by 37 %, and a decrease in diagnostic ERCPs by 57 % from 2002 to 2013. Mean length of stay was 7 days (SE = 0.01) and the mean cost of hospitalization was $20,022 (SE = 41).

Conclusions Our large cross-sectional study shows a significant shift in ERCPs towards therapeutic indications and a decline in its conventional diagnostic utility. Overall there has been a reduction in inpatient ERCPs.

• References

• 1 [Anonymous] NIH state-of-the-science statement on endoscopic retrograde cholangiopancreatography (ERCP) for diagnosis and therapy. NIH Consens State Sci Statements 2002; 19: 1-26
• 2 Adler DG, Baron TH, Davila RE. et al. ASGE guideline: the role of ERCP in diseases of the biliary tract and the pancreas. Gastrointest Endosc 2005; 62: 1-8
• 3 Sood N, Huckfeldt PJ, Escarce JJ. et al. Medicare's bundled payment pilot for acute and postacute care: analysis and recommendations on where to begin. Health Aff (Millwood) 2011; 30: 1708-1717
• 4 Healthcare Cost and Utilization P. HCUP Facts and Figures. In, HCUP Facts and Figures: Statistics on Hospital-Based Care in the United States, 2007. Rockville (MD): Agency for Healthcare Research and Quality (US); 2009
• 5 Mazen Jamal M, Yoon EJ, Saadi A. et al. Trends in the utilization of endoscopic retrograde cholangiopancreatography (ERCP) in the United States. Am J Gastroenterol 2007; 102: 966-975
• 6 Coelho-Prabhu N, Shah ND, Van Houten H. et al. Endoscopic retrograde cholangiopancreatography: utilisation and outcomes in a 10-year population-based cohort. BMJ Open 2013; 3
• 7 Akisik MF, Jennings SG, Aisen AM. et al. MRCP in patient care: a prospective survey of gastroenterologists. AJR Am J Roentgenol 2013; 201: 573-577
• 8 Sahel J, Barthet M, Gasmi M. The substitution of endoscopic ultrasonography for endoscopic retrograde cholangio-pancreatography: implications for service development and training. Eur J Gastroenterol Hepatol 2004; 16: 291-294
• 9 Cotton PB, Garrow DA, Gallagher J. et al. Risk factors for complications after ERCP: a multivariate analysis of 11,497 procedures over 12 years. In, Gastrointest Endosc. United States 2009: 80-88
• 10 Everhart JE, Khare M, Hill M. et al. Prevalence and ethnic differences in gallbladder disease in the United States. In, Gastroenterology. United States 1999: 632-639
• 11 Maurer KR, Everhart JE, Ezzati TM. et al. Prevalence of gallstone disease in Hispanic populations in the United States. Gastroenterology 1989; 96: 487-492
• 12 Jeurnink SM, Poley JW, Steyerberg EW. et al. ERCP as an outpatient treatment: a review. Gastrointest Endosc 2008; 68: 118-123
• 13 Freeman ML, Nelson DB, Sherman S. et al. Same-day discharge after endoscopic biliary sphincterotomy: observations from a prospective multicenter complication study. The Multicenter Endoscopic Sphincterotomy (MESH) Study Group. Gastrointest Endosc 1999; 49: 580-586
• 14 Hui CK, Lai KC, Wong WM. et al. Outpatients undergoing therapeutic endoscopic retrograde cholangiopancreatography: six-hour versus overnight observation. J Gastroenterol Hepatol 2004; 19: 1163-1168
• 15 Katsinelos P, Kountouras J, Chatzimavroudis G. et al. Outpatient therapeutic endoscopic retrograde cholangiopancreatography is safe in patients aged 80 years and older. Endoscopy 2011; 43: 128-133
• 16 Duncan HD, Hodgkinson L, Deakin M. et al. The safety of diagnostic and therapeutic ERCP as a daycase procedure with a selective admission policy. Eur J Gastroenterol Hepatol 1997; 9: 905-908
• 17 Shaheen AA, Kaplan GG, Myers RP. Weekend versus weekday admission and mortality from gastrointestinal hemorrhage caused by peptic ulcer disease. Clin Gastroenterol Hepatol 2009; 7: 303-310
• 18 Worni M, Schudel IM, Ostbye T. et al. Worse outcomes in patients undergoing urgent surgery for left-sided diverticulitis admitted on weekends vs weekdays: a population-based study of 31 832 patients. Arch Surg 2012; 147: 649-655
• 19 Palmer WL, Bottle A, Davie C. et al. Dying for the weekend: a retrospective cohort study on the association between day of hospital presentation and the quality and safety of stroke care. Arch Neurol 2012; 69: 1296-1302