衰弱对美国内镜逆行胰胆管造影术早期再入院的影响：我们目前的状况如何？
Impact of Frailty on Early Readmissions of Endoscopic Retrograde Cholangiopancreatography in the United States: Where Do We Stand?
作者信息
Pinnam Bhanu Siva Mohan, Dahiya Dushyant Singh, Chandan Saurabh, Gangwani Manesh Kumar, Ali Hassam, Singh Sahib, Hayat Umar, Iqbal Amna, Alsakarneh Saqr, Jaber Fouad, Mohamed Islam, Sohail Amir Humza, Sharma Neil
机构信息
Department of Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL 60612, USA.
Division of Gastroenterology, Hepatology & Motility, The University of Kansas School of Medicine, Kansas City, KS 66160, USA.
出版信息
J Clin Med. 2024 Oct 18;13(20):6236. doi: 10.3390/jcm13206236.
We assessed the impact of frailty on outcomes of endoscopic retrograde cholangiopancreatography (ERCP) in the United States. The National Readmission Database (2016-2020) was used to identify index and 30-day ERCP readmissions, which were categorized into low-frailty, intermediate-frailty, and high-frailty groups based on the Hospital Frailty Risk Score (HFRS). Outcomes were then compared. Of 885,416 index admissions, 9.9% were readmitted within 30 days of ERCP. The odds of 30-day readmission were higher in the intermediate-frailty group (12.59% vs. 8.2%, odds ratio [OR] 1.67, 95% confidence interval [CI] 1.64-1.71, < 0.001) and the high-frailty group (10.57% vs. 8.2%, OR 1.62, 95% CI 1.52-1.73, < 0.001) compared to the low-frailty group. On readmission, a higher HFRS also increased mean length of stay (intermediate-frailty vs. low-frailty: 8.49 vs. 4.22 days, mean difference (MD) 4.26, 95% CI 4.19-4.34, < 0.001; high-frailty vs. low-frailty: 10.9 vs. 4.22 days, MD 10.9 days, 95% CI 10.52-11.28, < 0.001) and mean total hospitalization charges (intermediate-frailty vs. low-frailty: $118,996 vs. $68,034, MD $50,962, 95% CI 48, 854-53,069, < 0.001; high-frailty vs. low-frailty: $195,584 vs. $68,034, MD $127,550, 95% CI 120,581-134,519, < 0.001). The odds of inpatient mortality were also higher for the intermediate-frailty and high-frailty compared to the low-frailty subgroup. Frailty was associated with worse clinical outcomes after ERCP.
我们评估了在美国虚弱对内镜逆行胰胆管造影术（ERCP）结果的影响。利用国家再入院数据库（2016 - 2020年）来识别初次ERCP及30天内的再入院情况，并根据医院虚弱风险评分（HFRS）将其分为低虚弱、中度虚弱和高虚弱组。然后对结果进行比较。在885,416例初次入院病例中，9.9%在ERCP术后30天内再次入院。与低虚弱组相比，中度虚弱组（12.59%对8.2%，比值比[OR] 1.67，95%置信区间[CI] 1.64 - 1.71，< 0.001）和高虚弱组（10.57%对8.2%，OR 1.62，95% CI 1.52 - 1.73，< 0.001）30天再入院的几率更高。再次入院时，较高的HFRS也增加了平均住院时间（中度虚弱组对低虚弱组：8.49天对4.22天，平均差值[MD] 4.26，95% CI 4.19 - 4.34，< 0.001；高虚弱组对低虚弱组：10.9天对4.22天，MD 10.9天，95% CI 10.52 - 11.28，< 0.001）以及平均总住院费用（中度虚弱组对低虚弱组：118,996美元对68,034美元，MD 50,962美元，95% CI 48,854 - 53,069，< 0.001；高虚弱组对低虚弱组：195,584美元对68,034美元，MD 127,550美元，95% CI 120,581 - 134,519，< 0.001）。与低虚弱亚组相比，中度虚弱和高虚弱组的住院死亡率几率也更高。虚弱与ERCP术后更差的临床结果相关。
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