P2273 - ERCP Is a Safe Procedure in Nonagenarian Patients Regardless of Frailty: A Nationwide Analysis

Sanket Basida, MD¹, Muhammad Nadeem. Yousaf, MD², Ghassan M. Hammoud, MD², Mythili Menon Pathiyil, MD^3
1University of Missouri at Columbia, Columbia, MO; ²University of Missouri-Columbia, Columbia, MO; ³Saint Vincent Hospital, Worcester, MA

Introduction: 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 high-risk population for ERCP related complications. We aimed to investigate the outcomes of ERCP in elderly (≥90 years) population.



Methods: This is a cohort study using 2019 National readmission database. Patients aged ≥90 were identified using ICD-10 code with clinical modification who underwent ERCP. Johns Hopkin’s adjusted clinical groups frailty indicator was used to classify patients as frail or non-frail. Readmission is defined as hospitalization due to non-trauma related diagnosis within 30 days from index admission. The primary outcome was morbidity. The secondary outcomes were mortality and 30-days readmission rate related to ERCP. We used univariate and multivariate regression models for statistical analysis.



Results: A total 3,322 patients, 65% female underwent ERCP were included in the analysis. Frail and non-frail patients were 1205 (36.27%) and 2,117 (63.72%) respectively. The indications of ERCP were choledocholithiasis (74.82%), biliary pancreatitis (9.81%), pancreaticobiliary cancer (7.52%), biliary stricture (3.83%), pancreatitis of unspecified etiology (2.24%), cholangitis (1.55%), abnormal LFTs (0.13%), and pancreatic pseudocyst (0.05%). The overall intra-procedural complications were non-significant between frail and non-frail patients. These include bleeding (0.31% vs 0.12%, p=0.29), accidental punctures/lacerations (0.81% vs 0.82%, p=0.98) and need for mechanical ventilation rates (2.69% vs 1.69%, p=0.14). Post ERCP complications rate were similar for bleeding (1.15% vs 0.63%, p=0.11), shock (0.09% vs 0.11%, p=0.93), and post-ERCP pancreatitis (3.5% vs 4.2%, p=0.83). Frail had a longer length of stay compared to non-frail patients (7 days vs 5 days, p< 0.001). The mortality rates of frail and non-frail patients were 2.09% vs 1.53%, p=0.59). The most common cause of 30-days readmission in both groups were sepsis (33.7%), pneumonia (14.87%), heart diseases (14.54%), and UTI (13.34%). There was no readmission due to ERCP related complications in both groups. All-cause 30-day readmission rates were identical between the two groups.





Discussion: ERCP is safe in elderly (≥90 years) population with a comparable morbidity, readmission and mortality rates in frail and non-frail patients. Larger, prospective studies are warranted to validate these results.




Disclosures:


Sanket Basida, MD¹, Muhammad Nadeem. Yousaf, MD², Ghassan M. Hammoud, MD², Mythili Menon Pathiyil, MD³. P2273 - ERCP Is a Safe Procedure in Nonagenarian Patients Regardless of Frailty: A Nationwide Analysis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.