Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Lucille Packard Children's Hospital at Stanford University Medical Centerr, Stanford, CA; Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA.
Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA.
J Pediatr. 2021 May;232:159-165.e1. doi: 10.1016/j.jpeds.2020.11.019. Epub 2020 Nov 14.
To analyze outcome and utilization trends over time of pediatric endoscopic retrograde cholangiopancreatography (ERCP) in an all-capture US population-level study.
Using the National Inpatient Sample (2005-2014) and National Readmission Database (2010-2014), we identified pediatric (age <20 years) hospitalizations during which ERCP was performed and assessed ERCP-associated readmissions. International Classification of Diseases, Ninth Revision, Clinical Modification codes were used to identify hospitalization diagnoses, comorbidities, and patient/hospital characteristics. Multivariate logistic regression analyses were performed to determine significant predictors (P < .05) of 30-day readmission.
A total of 11 060 hospitalized pediatric patients underwent ERCP between 2005 and 2014. Most were female (n = 8859; 81%), aged 14-20 years (n = 9342; 84%), and white (n = 4230; 45%). Most (85%) of ERCPs were therapeutic, and leading indications were biliary (n = 5350; 48%) and pancreatitis (n = 3218; 29%). Thirteen pecent of patients were readmitted post-ERCP. Odds for 30-day readmission were highest for patients with a history of liver transplantation, age 0-4 years, male sex, and obesity (P < .001 for each). Patients in both urban teaching and urban hospitals had much lower odds than those in rural hospitals for prolonged length of stay associated with ERCP.
These data represent a comprehensive study of nationwide trends in age-specific volumes and outcomes following ERCP in the pediatric population and provide important insights into trends in pediatric pancreaticobiliary disease management, as well as practice setting, patient characteristics, and patient comorbidities associated with pediatric post-ERCP outcomes, including readmission and length of stay.
在一项全美捕获的人群水平研究中，分析小儿内镜逆行胰胆管造影术（ERCP）的结果和随时间的利用趋势。
利用国家住院患者样本（2005-2014 年）和国家再入院数据库（2010-2014 年），我们确定了在小儿（年龄<20 岁）住院期间进行 ERCP 的住院患者，并评估了 ERCP 相关的再入院情况。使用国际疾病分类，第九版，临床修正码来识别住院诊断、合并症和患者/医院特征。采用多变量逻辑回归分析确定 30 天再入院的显著预测因素（P<.05）。
2005 年至 2014 年期间，共有 11060 名住院小儿患者接受了 ERCP。大多数为女性（n=8859；81%），年龄 14-20 岁（n=9342；84%），白人（n=4230；45%）。大多数 ERCP 为治疗性的，主要指征为胆道疾病（n=5350；48%）和胰腺炎（n=3218；29%）。13%的患者在 ERCP 后再入院。30 天再入院的几率在有肝移植史、年龄 0-4 岁、男性和肥胖的患者中最高（P<.001）。与农村医院相比，城市教学医院和城市医院的患者接受 ERCP 后，与延长住院时间相关的 30 天再入院的几率要低得多。
这些数据代表了对小儿人群中 ERCP 后按年龄划分的数量和结果的全国性趋势的综合研究，为小儿胰胆疾病管理的趋势提供了重要的见解，以及与小儿 ERCP 后结果相关的实践环境、患者特征和患者合并症，包括再入院和住院时间。
