Impact of frailty on endoscopic retrograde cholangiopancreatography outcomes in nonagenarians:A United States national experience  

作　　者：Sanket Dhirubhai Basida Dushyant Singh Dahiya Muhammad Nadeem Yousaf Brinda Basida Bhanu Siva Mohan Pinnam Manesh Kumar Gangwani Hassam Ali Sahib Singh Yash R Shah Daksh Ahluwalia Mihir Prakash Shah Saurabh Chandan Neil R Sharma Shyam Thakkar 

机构地区：[1]Department of Internal Medicine,University of Missouri-Columbia,Columbia,MO 65212,United States [2]Division of Gastroenterology,Hepatology&Motility,The University of Kansas School of Medicine,Kansas City,KS 66160,United States [3]Division of Gastroenterology and Hepatology,University of Missouri,Columbia,MO 65212,United States [4]Department of Rheumatology,Medical College of Georgia,Augusta University,North Augusta,GA 30912,United States [5]Department of Internal Medicine,John H.Stroger Hospital of Cook County,Chicago,IL 60612,United States [6]Department of Internal Medicine,The University of Toledo,Toledo,OH 43606,United States [7]Division of Gastroenterology and Hepatology,East Carolina University/Brody School of Medicine,Greenville,NC 27858,United States [8]Department of Internal Medicine,Sinai Hospital,Baltimore,MD 21215,United States [9]Department of Internal Medicine,Trinity Health Oakland/Wayne State University,Pontiac,MI 48341,United States [10]Division of Gastroenterology and Hepatology,Creighton University School of Medicine,Omaha,NE 68131,United States [11]Division of Interventional Oncology&Surgical Endoscopy,GI Oncology Tumor Site Team,Parkview Cancer Institute,Parkview Health,Fort Wayne,IN 46845,United States [12]Section of Gastroenterology&Hepatology,West Virginia University School of Medicine,Morgantown,WV 26505,United States

出　　处：《World Journal of Gastrointestinal Endoscopy》2024年第3期148-156,共9页世界胃肠内镜杂志（英文版）（电子版）

摘　　要：BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an essential therapeutic tool for biliary and pancreatic diseases.Frail and elderly patients,especially those aged≥90 years are generally considered a higher-risk population for ERCP-related complications.AIM To investigate outcomes of ERCP in the Non-agenarian population(≥90 years)concerning Frailty.METHODS This is a cohort study using the 2018-2020 National Readmission Database.Patients aged≥90 were identified who underwent ERCP,using the international classification of diseases-10 code with clinical modification.Johns Hopkins’s adjusted clinical groups frailty indicator was used to classify patients as frail and non-frail.The primary outcome was mortality,and the secondary outcomes were morbidity and the 30 d readmission rate related to ERCP.We used univariate and multivariate regression models for analysis.RESULTS A total of 9448 patients were admitted for any indications of ERCP.Frail and non-frail patients were 3445(36.46%)and 6003(63.53%)respectively.Indications for ERCP were Choledocholithiasis(74.84%),Biliary pancreatitis(9.19%),Pancreatico-biliary cancer(7.6%),Biliary stricture(4.84%),and Cholangitis(1.51%).Mortality rates were higher in frail group[adjusted odds ratio(aOR)=1.68,P=0.02].The Intra-procedural complications were insigni-ficant between the two groups which included bleeding(aOR=0.72,P=0.67),accidental punctures/lacerations(aOR=0.77,P=0.5),and mechanical ventilation rates(aOR=1.19,P=0.6).Post-ERCP complication rate was similar for bleeding(aOR=0.72,P=0.41)and post-ERCP pancreatitis(aOR=1.4,P=0.44).Frail patients had a longer length of stay(6.7 d vs 5.5 d)and higher mean total charges of hospitalization($78807 vs$71392)compared to controls(P<0.001).The 30 d all-cause readmission rates between frail and non-frail patients were similar(P=0.96).CONCLUSION There was a significantly higher mortality risk and healthcare burden amongst nonagenarian frail patients undergoing ERCP compared to non-frail.Larger studies are warrant

关 键 词：Endoscopic retrograde cholangiopancreatography NONAGENARIANS FRAILTY MORTALITY Healthcare burden 

分 类 号：R575[医药卫生—消化系统]