Burdens of Postoperative Infection in Endoscopic Retrograde Cholangiopancreatography Inpatients

Abstract

Objectives Our objective in this study is, firstly, to determine postoperative (POI) rates in endoscopic retrograde cholangiopancreatography (ERCP) procedures stratified by patients’ demographic and hospitals’ characteristics in the United States, and secondly, to evaluate the demographic and comorbid risk factors associated with POI in ERCP inpatients, as well as its impact on the length of stay (LOS) and total charges. Methods The total sample of 28,525 inpatients with a principal procedure of ERCP from the Nationwide Inpatient Sample (NIS) was included and grouped by co-diagnosis of POI (N=300, 1.05%). We used a logistic regression model and descriptive statistics for the POI rate estimates. Results High POI rate was seen in males (1.14%), and adults (36-50 years, 1.25%) with 2.65 times (95% CI 1.69-4.12) higher odds compared to young adults. POI rate in ERCP inpatients varied widely according to geographic region: higher in the West (1.46%) and Northeast (1.20%) and lowest in the Midwest (0.70%). As per the hospital characteristics, inpatients in public (1.26%), urban teaching (1.39%) and small bed-size (1.27%) hospitals had higher POI rates. ERCP inpatients with POI had higher odds of association with comorbid HIV infection (OR 1.55, 95% CI 1.13-2.12) and diabetes (OR 1.43, 95% CI 1.09-1.85). ERCP inpatients with POI had a significantly longer length of stay (LOS) by 5.2 days and higher total charges by USD 53,966 than inpatients without POI. Conclusions POI is associated with acute inpatient care, with longer hospitalization stays and higher costs, leading to increased healthcare burdens. The main goal is to identify the risk factors and to prevent POI with prophylactic antibiotics.

Etiology and Comorbidity Diagnoses Effect on Outcomes for Patients Undergoing Endoscopic Retrograde Cholangiopancreatography

“…Looking at each comorbidity individually, these were chosen for their known ability to negatively impact surgical outcomes. CLD, as stated, has been previously linked to negative ERCP outcomes, and this is likely due to its extensive part in producing clotting factors and processing toxins [4][5]. For similar reasons, patients with a coagulopathy disorder are likely to experience negative outcomes due to bleeding or clotting risks.…”

“…These patients could have clotting disorders due to liver dysfunction, as well as an inability for physicians to compensate by using medications that worked through a renal excretion mechanism [5]. Additionally, liver dysfunction can lead to renal dysfunction independently, making this an additive effect in the setting of CLD and acute kidney failure [4].…”

“…CHF patients can experience cardiac dysfunction and volume expansion that can affect post-surgical healing [ 9 ]. DM can lead to a decreased immune response and increased virulence of infectious agents, meaning that any postoperative infection complication is more likely to lead to negative patient outcomes than for those without DM [ 4 ]. Due to factors related to each comorbidity, patients with each comorbidity are likely to experience the negative patient outcomes described in this study related to ERCP.…”

“…DM was chosen based on previous studies that have linked perioperative hyperglycemia due to DM to adverse outcomes and surgical complications. Concomitant diabetes mellitus in patients undergoing ERCP is related to higher rates of postoperative infections (POI) as hyperglycemia increases the virulence of infectious microorganisms and causes apoptosis of polymorphonuclear neutrophils [4]. This leads to low neutrophil counts and diminished T-lymphocyte response, often causing bacteremia.…”

“…POI leads to a higher need for inpatient care and higher total costs. Similarly, in patients with CLD, cirrhosis can contribute to higher surgical risk due to compromised liver function from the liver pathology itself and additional coagulopathies, anemia, and renal dysfunction that it can cause [4]. Procedure-related gastrointestinal bleeds are statistically more significant post-ERCP in compensated cirrhosis due to the development of coagulation disorders and low platelet counts, platelet dysfunction, and powerful collateral vasculature in the duodenal area as a result of portal hypertension [5].…”