1] Division of Gastroenterology, Hepatology, and Nutrition, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA [2] Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Division of Gastroenterology, Hepatology, and Nutrition, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Am J Gastroenterol. 2014 Apr;109(4):465-70. doi: 10.1038/ajg.2013.362.
Endoscopic retrograde cholangiopancreatography (ERCP) performed on the weekend requires significant effort from the endoscopist, nursing staff, and anesthesia services. These factors often result in delaying the procedure until the following Monday. No data exist on whether performing weekend ERCP reduces length of stay (LOS) and total cost to justify the additional physician and nursing burden.
In this single tertiary academic center, institutional review board-approved study, we retrospectively reviewed all hospitalized patients in whom an ERCP had been completed from May 2010 to September 2011. Demographic and clinical information, procedure details as well as total hospitalization charges (USD) were compared between patients who had an ERCP either on the weekend or weekday holiday (WE ERCP) or Monday (MON ERCP). Statistical comparisons were made using χ(2) and Fischer's exact test. A logistic regression model adjusted for propensity scores (PSs) was used to estimate the risk in prolonged LOS and high total charges associated with WE ERCPs vs. MON ERCPs.
A total of 1,114 ERCP's were performed during the time period, 123 of which met inclusion criteria (52 WE, 71 MON). Mean patient age was 56.3±16.7 years (54.5% female, 60.2% Caucasian). There were no significant demographic differences between the two groups. The most common procedure indications were choledocholithiasis (34.9%) and elevated liver enzymes after liver transplantation (25.2%). The analysis showed a significantly decreased LOS (P=0.010) and a trend towards decreased cost (P=0.050) associated with WE ERCP. In the multivariate analysis adjusted for PS, WE ERCP had a significantly decreased odds ratio of LOS>3 days (odds ratio: 0.37 (0.16-0.85); P=0.019).
We demonstrated a significant decrease in LOS and a trend towards decrease in charges in patients who underwent weekend ERCP compared with delaying ERCP until Monday. Thus, health-care organizations should consider removing barriers to weekend inpatient ERCPs.
周末进行的内镜逆行胰胆管造影术（ERCP）需要内镜医生、护理人员和麻醉服务的大量努力。这些因素常常导致手术延迟至下周一进行。目前尚无数据表明周末进行 ERCP 是否会缩短住院时间（LOS）和总费用，从而证明增加医生和护理人员的负担是合理的。
在这项单中心的三级学术中心回顾性研究中，我们回顾了 2010 年 5 月至 2011 年 9 月期间所有接受 ERCP 治疗的住院患者。比较周末（WE ERCP）或工作日假期（MON ERCP）与周一（MON ERCP）进行 ERCP 的患者的人口统计学和临床信息、手术细节以及总住院费用（美元）。使用 χ(2)和 Fischer 精确检验进行统计学比较。使用倾向评分（PS）调整的逻辑回归模型来估计与 WE ERCP 相比，MON ERCP 与延长 LOS 和高总费用相关的风险。
在研究期间共进行了 1114 例 ERCP，其中 123 例符合纳入标准（52 例 WE，71 例 MON）。患者平均年龄为 56.3±16.7 岁（54.5%为女性，60.2%为白种人）。两组间无显著的人口统计学差异。最常见的手术适应证是胆总管结石（34.9%）和肝移植后肝酶升高（25.2%）。分析显示，WE ERCP 与 LOS 显著缩短（P=0.010）和费用降低呈趋势（P=0.050）相关。在调整 PS 的多变量分析中，WE ERCP 与 LOS>3 天的比值比显著降低（比值比：0.37（0.16-0.85）；P=0.019）。
与将 ERCP 推迟至周一相比，我们发现在周末进行 ERCP 的患者的 LOS 显著缩短，费用也呈下降趋势。因此，医疗机构应考虑消除周末住院患者进行 ERCP 的障碍。
