Predictors of 30-Day Readmission After Inpatient Endoscopic Retrograde Cholangiopancreatography: A Single-Center Experience

Timothy S. Krill, Rebecca Crain, Yamam Al-Saadi, Samantha Stubbs, Russell Roark, Ahmed Chatila, Christina Haddad, Chandni Kaushik, Felippe Marcondes, Praveen Guturu, Sreeram Parupudi

Research output: Contribution to journalArticle

Abstract

Introduction: The 30-day hospital readmission rate is a nationally recognized quality measure. Nearly one-fifth of medicare beneficiaries are hospitalized within 30 days of discharge, resulting in a cost of over $26 billion dollars annually. Endoscopic retrograde cholangiopancreatography (ERCP) remains the endoscopic procedure with the highest risk of morbidity and mortality. We set out to analyze the clinical characteristics predictive of 30-day readmission after an inpatient ERCP. Methods: We performed a retrospective chart review of all inpatient ERCPs performed at our institution between 12/1/2014 and 9/30/2018. Clinical characteristics and outcomes of these patients were compared to determine predictors of 30-day readmission. Results: A total of 497 inpatient ERCP procedures done for biliary or pancreatic indications, constituting 483 patients, were identified. There were 52 readmissions that occurred among 48 patients within 30 days of discharge. Basic demographic characteristics were similar between both groups. Comorbidities were significantly higher in those who were readmitted. Multivariate analysis revealed significantly greater odds of readmission with prior liver transplantation (OR = 4.15), cirrhosis (OR = 3.20), and pancreatic duct stent placement (OR = 2.56). Subgroup analysis for biliary indications revealed cholecystectomy before discharge and early ERCP to be protective against readmission. Conclusion: A history of liver transplantation and cirrhosis are predictive of increased 30-day readmission rates after an inpatient ERCP. Pancreatic duct stent placement is associated with readmission; however, this phenomenon is likely related to stenting for pancreatic endotherapy. Cholecystectomy before discharge and early ERCP are predictive of decreased need for readmission in procedures done for biliary indications.

Original languageEnglish (US)
JournalDigestive Diseases and Sciences
DOIs
StateAccepted/In press - Jan 1 2019

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Endoscopic Retrograde Cholangiopancreatography
Inpatients
Pancreatic Ducts
Cholecystectomy
Liver Transplantation
Stents
Patient Readmission
Medicare
Liver Cirrhosis
Comorbidity
Fibrosis
Multivariate Analysis
Demography
Morbidity
Costs and Cost Analysis
Mortality

Keywords

  • Endoscopic retrograde cholangiopancreatography (ERCP)
  • Endoscopy
  • Quality
  • Readmission

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology

Cite this

Predictors of 30-Day Readmission After Inpatient Endoscopic Retrograde Cholangiopancreatography : A Single-Center Experience. / Krill, Timothy S.; Crain, Rebecca; Al-Saadi, Yamam; Stubbs, Samantha; Roark, Russell; Chatila, Ahmed; Haddad, Christina; Kaushik, Chandni; Marcondes, Felippe; Guturu, Praveen; Parupudi, Sreeram.

In: Digestive Diseases and Sciences, 01.01.2019.

Research output: Contribution to journalArticle

Krill, Timothy S. ; Crain, Rebecca ; Al-Saadi, Yamam ; Stubbs, Samantha ; Roark, Russell ; Chatila, Ahmed ; Haddad, Christina ; Kaushik, Chandni ; Marcondes, Felippe ; Guturu, Praveen ; Parupudi, Sreeram. / Predictors of 30-Day Readmission After Inpatient Endoscopic Retrograde Cholangiopancreatography : A Single-Center Experience. In: Digestive Diseases and Sciences. 2019.
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T2 - A Single-Center Experience

AU - Krill, Timothy S.

AU - Crain, Rebecca

AU - Al-Saadi, Yamam

AU - Stubbs, Samantha

AU - Roark, Russell

AU - Chatila, Ahmed

AU - Haddad, Christina

AU - Kaushik, Chandni

AU - Marcondes, Felippe

AU - Guturu, Praveen

AU - Parupudi, Sreeram

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N2 - Introduction: The 30-day hospital readmission rate is a nationally recognized quality measure. Nearly one-fifth of medicare beneficiaries are hospitalized within 30 days of discharge, resulting in a cost of over $26 billion dollars annually. Endoscopic retrograde cholangiopancreatography (ERCP) remains the endoscopic procedure with the highest risk of morbidity and mortality. We set out to analyze the clinical characteristics predictive of 30-day readmission after an inpatient ERCP. Methods: We performed a retrospective chart review of all inpatient ERCPs performed at our institution between 12/1/2014 and 9/30/2018. Clinical characteristics and outcomes of these patients were compared to determine predictors of 30-day readmission. Results: A total of 497 inpatient ERCP procedures done for biliary or pancreatic indications, constituting 483 patients, were identified. There were 52 readmissions that occurred among 48 patients within 30 days of discharge. Basic demographic characteristics were similar between both groups. Comorbidities were significantly higher in those who were readmitted. Multivariate analysis revealed significantly greater odds of readmission with prior liver transplantation (OR = 4.15), cirrhosis (OR = 3.20), and pancreatic duct stent placement (OR = 2.56). Subgroup analysis for biliary indications revealed cholecystectomy before discharge and early ERCP to be protective against readmission. Conclusion: A history of liver transplantation and cirrhosis are predictive of increased 30-day readmission rates after an inpatient ERCP. Pancreatic duct stent placement is associated with readmission; however, this phenomenon is likely related to stenting for pancreatic endotherapy. Cholecystectomy before discharge and early ERCP are predictive of decreased need for readmission in procedures done for biliary indications.

AB - Introduction: The 30-day hospital readmission rate is a nationally recognized quality measure. Nearly one-fifth of medicare beneficiaries are hospitalized within 30 days of discharge, resulting in a cost of over $26 billion dollars annually. Endoscopic retrograde cholangiopancreatography (ERCP) remains the endoscopic procedure with the highest risk of morbidity and mortality. We set out to analyze the clinical characteristics predictive of 30-day readmission after an inpatient ERCP. Methods: We performed a retrospective chart review of all inpatient ERCPs performed at our institution between 12/1/2014 and 9/30/2018. Clinical characteristics and outcomes of these patients were compared to determine predictors of 30-day readmission. Results: A total of 497 inpatient ERCP procedures done for biliary or pancreatic indications, constituting 483 patients, were identified. There were 52 readmissions that occurred among 48 patients within 30 days of discharge. Basic demographic characteristics were similar between both groups. Comorbidities were significantly higher in those who were readmitted. Multivariate analysis revealed significantly greater odds of readmission with prior liver transplantation (OR = 4.15), cirrhosis (OR = 3.20), and pancreatic duct stent placement (OR = 2.56). Subgroup analysis for biliary indications revealed cholecystectomy before discharge and early ERCP to be protective against readmission. Conclusion: A history of liver transplantation and cirrhosis are predictive of increased 30-day readmission rates after an inpatient ERCP. Pancreatic duct stent placement is associated with readmission; however, this phenomenon is likely related to stenting for pancreatic endotherapy. Cholecystectomy before discharge and early ERCP are predictive of decreased need for readmission in procedures done for biliary indications.

KW - Endoscopic retrograde cholangiopancreatography (ERCP)

KW - Endoscopy

KW - Quality

KW - Readmission

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