Division of Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, UT, USA.
Department of Medicine, Jersey Shore University Medical Center, Neptune City, NJ, USA.
Dig Dis Sci. 2023 Sep;68(9):3605-3613. doi: 10.1007/s10620-023-08013-0. Epub 2023 Jun 27.
Pancreaticobiliary diseases are common in the elderly. To this end, frailty represents a state of vulnerability that should be considered when assessing the risks and benefits of therapeutic endoscopic procedures. We aim to determine the rate of readmissions and clinical outcomes using the validated Hospital Frailty Risk Score in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP).
Using the National Readmissions Database, we identified patients with an admission diagnosis of cholangitis with obstructive stone from 2016 to 2019. Patients were determined to be of low frailty risk with a score of < 5, while patients of medium to high frailty risk had a score of > 5.
During the study period, 5751 patients were identified with acute cholangitis with obstructing stone. Mean age of index admissions was 69.4 years and 51.8% were female. From the total cohort, 5119 (89.2%) patients underwent therapeutic ERCP, 38.0% (n = 1947) of whom were regarded as frail (risk score > 5). Following ERCP, frail patients had a less but statistically insignificant readmission rate compared to non-frail patients (2.76% vs 4.05%, p = 0.450). However, compared to non-frail patients, frail patients experienced higher post-ERCP complications (6.20% vs 14.63%, p < 0.001). Frail patients were more likely to have longer lengths of stay, higher hospital cost, and mortality risk.
ERCP is not a risk factor for readmission among frail patients. However, frail patients are at higher risk for procedure-related complications, healthcare utilization, and mortality.
胰胆疾病在老年人中较为常见。为此，脆弱代表一种易损状态，在评估治疗性内镜手术的风险和获益时应予以考虑。我们旨在使用经过验证的医院脆弱风险评分（Hospital Frailty Risk Score）确定接受内镜逆行胰胆管造影术（endoscopic retrograde cholangiopancreatography，ERCP）的患者的再入院率和临床结局。
我们使用国家再入院数据库（National Readmissions Database），确定了 2016 年至 2019 年期间因胆管炎合并梗阻性结石入院的患者。评分<5 分的患者被认为处于低脆弱风险，评分>5 分的患者则处于中至高脆弱风险。
在研究期间，共确定了 5751 例急性胆管炎合并梗阻性结石患者。指数入院时的平均年龄为 69.4 岁，51.8%为女性。在总队列中，5119 例（89.2%）患者接受了治疗性 ERCP，其中 38.0%（n=1947）被认为是脆弱的（风险评分>5）。与非脆弱患者相比，ERCP 后脆弱患者的再入院率虽较低，但无统计学意义（2.76% vs 4.05%，p=0.450）。然而，与非脆弱患者相比，脆弱患者术后并发症发生率更高（6.20% vs 14.63%，p<0.001）。脆弱患者的住院时间更长、住院费用更高，且死亡风险更大。
ERCP 并不是脆弱患者再入院的危险因素。然而，脆弱患者在与操作相关的并发症、医疗保健利用和死亡风险方面处于更高风险。
