Marshfield Clinic, Marshfield, WI, USA.
University of Utah School of Medicine, Salt Lake City, UT, USA -
Minerva Gastroenterol (Torino). 2021 Sep;67(3):276-282. doi: 10.23736/S2724-5985.20.02718-X. Epub 2020 Jun 2.
Intestinal perforation is a rare but feared complication of ERCP. In this study, we identify patient and hospital factors for ERCP related intestinal perforation using a large national database. We also examine the effects of intestinal perforations on hospital outcomes.
Data were obtained from the National Inpatient Sample, the largest publicly available inpatient care database in the United States. ICD-9-CM procedure codes for all ERCP procedures conducted between 1998 and 2013. Our primary outcome of interest was the incidence of intestinal perforations after ERCP. Secondary outcomes of interest included hospital length of stay and inpatient mortality.
A total of 392,336 ERCP procedures were performed over the study period, met our inclusion criteria, and were analyzed. Mean age of sample was 59 years and just over 60% were females. Low volume hospitals accounted for over 85% of ERCPs. Intestinal perforations occurred at a rate of 1.2 per 1000 ERCP procedures. Patient's age was the only patient-related factor significantly associated with perforation. (OR: 1.016; 95% CI 1.009-1.025). For hospitals, teaching status was the only hospital related factor associated with intestinal perforation after ERCP (OR: 1.56; 95% CI 1.28-1.91). Length of stay was much longer in patients with ERCP related perforations and mortality risk was ten times higher in the same cohort.
Patients who have ERCP related perforations have longer hospital stays and have a higher mortality risk. Older patients and those who had ERCP in teaching hospitals are at a higher risk of perforation.
肠穿孔是 ERCP 罕见但可怕的并发症。在这项研究中，我们使用大型国家数据库确定与 ERCP 相关的肠穿孔的患者和医院因素。我们还研究了肠穿孔对医院结果的影响。
数据来自美国最大的公开住院治疗数据库国家住院患者样本。1998 年至 2013 年间进行的所有 ERCP 程序的 ICD-9-CM 程序代码。我们感兴趣的主要结果是 ERCP 后肠穿孔的发生率。次要结果包括住院时间和住院死亡率。
在研究期间共进行了 392336 例 ERCP 手术，符合我们的纳入标准并进行了分析。样本的平均年龄为 59 岁，超过 60%为女性。低容量医院占 ERCP 的 85%以上。肠穿孔的发生率为每 1000 例 ERCP 手术 1.2 例。患者年龄是唯一与穿孔显著相关的患者相关因素。（OR：1.016；95%CI 1.009-1.025）。对于医院，教学地位是 ERCP 后与肠穿孔相关的唯一医院相关因素（OR：1.56；95%CI 1.28-1.91）。与 ERCP 相关的穿孔患者的住院时间要长得多，同一队列的死亡率风险高出十倍。
患有 ERCP 相关穿孔的患者住院时间更长，死亡率风险更高。年龄较大的患者和在教学医院接受 ERCP 的患者穿孔风险更高。
