PREVALENCE TREND, HOSPITAL UTILIZATION, AND PREDICTORS OF UTILIZATION OF ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN ACUTE PANCREATITIS HOSPITALIZATION.

Background: Acute pancreatitis (AP) is a sudden inflammation of the pancreas, and biliary pancreatitis remains the most common cause of AP. Endoscopic retrograde cholangiopancreatography (ERCP) is very commonly used in AP with coexisting acute cholangitis or biliary obstruction. There was a need for a nationwide study to evaluate ERCP utilization trends and healthcare costs amongst AP patients

Methods: We performed a population-based retrospective analysis of the Nationwide Inpatient Sample data (years 2003-2014) in adult (>18 years) AP hospitalizations using ICD-9-CM codes. We performed a chi-square test, ttest, and Jonckheere’s trend test to evaluate characteristics of the ERCP cohort, prevalence trend, hospital utilization cost, and length of stay (LOS). The multivariate survey logistic regression model was weighted to account for sampling strategy, to evaluate predictors of utilization for ERCP among AP hospitalization. The model was adjusted for patient’s demographics like gender and race, comorbidities like hypertension, diabetes, hypercholesterolemia, substance, alcohol and tobacco abuse, HIV, renal failure, Charlson’s Comorbidity Index, and admission and hospital-level characteristics admission day, type, payer, location, and teaching status of the hospital.

Results: In this analysis, among 2,632,309 hospitalizations for AP, 49108 (1.87%) had ERCP. The prevalence trend of ERCP declined from 3.88% in year 2003 to 0.97% in year 2014. (pTrend<0.0001). Patients with ERCP were older (>55 year old) (53.01% vs 39.36%; p<0.0001), female (58.45% vs © Clarivate Analytics | © ScholarOne, Inc., 2019. All Rights Reserved. ScholarOne Abstracts and ScholarOne are registered trademarks of ScholarOne, Inc. ScholarOne Abstracts Patents #7,257,767 and #7,263,655. @ScholarOneNews | System Requirements | Privacy Statement | Terms of UseProduct version number 4.16.0 (Build 112). Build date Tue Nov 5 14:19:03 EST 2019. Server ip-10-236-26-8648.04%; p<0.0001), hispanic (16.30% vs 12.86%; p<0.0001), utilizing medicare (40.29% vs 31.88%; p<0.0001), elective admission (8.15% vs 4.98%; p<0.0001), and with gallbladder etiology (65.98% vs 26.06%; p<0.0001). AP hospitalization with ERCP had higher cost of utilization ($56338 vs $31261; diff=$25077; p<0.0001) and mean LOS (8.6 vs 5.1 days; diff=3.5; p<0.0001). In regression analysis, old adults [Odds ratio (OR):1.087; Confidence interval (CI):1.008-1.173), hispanic (OR:1.086; CI:1.019-1.156), asian (OR:1.146; CI:1.007-1.304), female (OR:1.074; CI:1.028-1.122), elective admission (OR:1.649; CI:1.524-1.785), gallbladder etiology (OR:4.437; CI:4.224-4.662), concurrent chronic pancreatitis (OR:1.643; CI:1.536-1.757), SIRS (OR:1.264; CI:1.112-1.436), pleural effusion (OR:1.874; CI:1.231-2.854) and pulmonary venous thrombosis (OR:1.646; CI:1.221-2.219).

Conclusions: In nationwide data, we have found the decreased utilization trend and higher hospital utilization cost and stay associated with ERCP. The predictors of utilization will be helpful to examine the cost-utility of ERCP, especially with the advent of AP treatment systems to mitigate health care burden.