Schulman Allison R, Abougergi Marwan S, Thompson Christopher C
Allison R Schulman, Christopher C Thompson, Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States.
World J Gastrointest Endosc. 2017 Jul 16;9(7):296-303. doi: 10.4253/wjge.v9.i7.296.
To assess incidence of post-endoscopic retrograde cholangiopancreatography (post-ERCP) pancreatitis in the early (July/August/September) the late (April/May/June) academic year and evaluate in-hospital mortality, length of stay (LOS), and total hospitalization charge between these time periods.
This was a retrospective cohort study using the 2012 Nationwide Inpatient Sample (NIS). Patients with International Classification of Diseases, 9 Revision, Clinical Modification (ICD-9 CM) procedure codes for ERCP were included. Patients were excluded from the study if they had an ICD-9 CM code for a principal diagnosis of acute pancreatitis, if the ERCP was performed before or on the day of admission or if they were admitted to non-teaching hospitals. Post-ERCP pancreatitis was defined as an ICD-9 CM code for a secondary diagnosis of acute pancreatitis in patients who received an ERCP as delineated above. ERCPs performed during the months of July, August and September was compared to those performed in April, May and June in academic hospitals. ERCPs performed at academic hospitals during the early late year were compared. Primary outcome was incidence of post-ERCP pancreatitis. Secondary outcomes included in-hospital mortality, length of stay (LOS), and total hospitalization charge. Proportions were compared using fisher's exact test and continuous variables using student -test. Multivariable regression was performed.
From the 36480032 hospitalizations in 2012 in the United States, 6248 were included in the study (3065 in July/August/September and 3183 in April/May/June) in the 2012 academic year. Compared with patients admitted in July/August/September, patients admitted in April/May/June had no statistical difference in all variables including mean age, percent female, Charleston comorbidity index, race, median income, and hospital characteristics including region, bed size, and location. Incidence of post-ERCP pancreatitis in early late academic year were not statistically significant (OR = 1.03, 95%CI: 0.71-1.51, = 0.415). Similarly, the adjusted odds ratio of mortality, LOS, and total hospitalization charge in early compared to late academic year were not statistically significant.
Incidence of post-ERCP pancreatitis does not differ at academic institutions depending on the time of year. Similarly, mortality, LOS, and total hospital charge do not demonstrate the existence of a temporal effect, suggesting that trainee level of experience does not impact clinical outcomes in patients undergoing ERCP.
评估学年早期（7月/8月/9月）和晚期（4月/5月/6月）内镜逆行胰胆管造影术后（ERCP术后）胰腺炎的发生率，并评估这两个时间段内的住院死亡率、住院时间（LOS）和总住院费用。
这是一项使用2012年全国住院患者样本（NIS）的回顾性队列研究。纳入具有国际疾病分类第9版临床修订本（ICD-9 CM）ERCP手术编码的患者。如果患者的主要诊断为急性胰腺炎的ICD-9 CM编码、ERCP在入院前或入院当天进行，或者他们入住非教学医院，则将其排除在研究之外。ERCP术后胰腺炎定义为上述接受ERCP治疗的患者中急性胰腺炎二级诊断的ICD-9 CM编码。将7月、8月和9月进行的ERCP与学术医院4月、5月和6月进行的ERCP进行比较。比较学年早期和晚期在学术医院进行的ERCP。主要结局是ERCP术后胰腺炎的发生率。次要结局包括住院死亡率、住院时间（LOS）和总住院费用。使用Fisher精确检验比较比例，使用学生t检验比较连续变量。进行多变量回归分析。
在2012年美国的36480032次住院治疗中，2012学年有6248例纳入研究（7月/8月/9月为3065例，4月/5月/6月为3183例）。与7月/8月/9月入院的患者相比，4月/5月/6月入院的患者在所有变量上均无统计学差异，包括平均年龄、女性百分比、Charleston合并症指数、种族、收入中位数以及医院特征，包括地区、床位规模和位置。学年早期和晚期ERCP术后胰腺炎的发生率无统计学意义（OR = 1.03，95%CI：0.71 - 1.51，P = 0.415）。同样，与学年晚期相比，学年早期死亡率、住院时间（LOS）和总住院费用的调整优势比也无统计学意义。
在学术机构中，ERCP术后胰腺炎的发生率不因一年中的时间而异。同样，死亡率、住院时间（LOS）和总住院费用也未显示出时间效应的存在，这表明实习医生的经验水平不会影响接受ERCP治疗患者的临床结局。
