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Sunday Poster Session

Category: Interventional Endoscopy

P0855 - Impact of Frailty on Early Readmissions of Endoscopic Retrograde Cholangiopancreatography in the United States

Sunday, October 22, 2023
3:30 PM – 7:00 PM PT
Location: Exhibit Hall
Has Audio
Bhanu Siva Mohan Pinnam, MD1, Dushyant Singh. Dahiya, MD2, Saurabh Chandan, MD3, Hassam Ali, MD4, Manesh Kumar Gangwani, MD5, Harishankar Gopakumar, MD6, Ishaan Vohra, MD6, Daksh Ahluwalia, MD1, Jay Bapaye, MBBS, MD7, Mohammad Al-Haddad, MD8, Neil Sharma, MD9
1John H. Stroger, Jr. Hospital of Cook County, Chicago, IL; 2University of Kansas School of Medicine, Kansas City, KS; 3Creighton University School of Medicine, Omaha, NE; 4ECU Health Medical Center / Brody School of Medicine, Greenville, NC; 5University of Toledo, Toledo, OH; 6University of Illinois, Peoria, IL; 7Rochester General Hospital, Rochester, NY; 8Indiana University, Indianapolis, IN; 9Parkview Health, Fort Wayne, IN

Introduction: Frailty is associated with decreased physiologic reserve, increased vulnerability to stressors, and a higher risk for adverse health outcomes. It is an important risk factor for poor clinical outcomes in medical and surgical settings. In this study, we aimed to assess the impact of frailty on 30-day readmissions of ERCP in the United States.

Methods: The National Readmission Database was utilized from 2016-2020 to identify adult hospitalizations that underwent ERCP on index admission and those that were readmitted within 30 days of the procedure. The study population was further subdivided based on the Hospital Frailty Risk Score (HFRS) into low (HFRS< 5), intermediate (HFRS 5-15), and high frailty (HFRS >15) groups. Readmission rates were compared using univariate logistic regression, and linear regression was used to compare the mean length of stay (LOS) and mean total hospitalization charges (THC) between these groups. All p-values < 0.05 were statistically significant.

Results: Between 2016 and 2020, 885,416 hospitalizations underwent ERCP on index admissions. Of these, 88,380 (9.9%) were readmitted within 30 days. Compared to the low-frailty group, the intermediate-frailty group [8.2% vs. 12.59%, odds ratio (OR) 1.67, 95% confidence interval (CI) 1.64-1.71, p< 0.001] and high-frailty group (10.57% vs. 8.2%, OR 1.62, 95% CI 1.52-1.73, p< 0.001) had higher odds of readmission after ERCP in index readmission.
Frailty was also associated with increased healthcare utilization on 30-day readmission. We noted longer mean LOS for the intermediate frailty (8.49 vs. 4.22 days, mean difference [MD] 4.26, 95% CI 4.19-4.34, p< 0.001), and high-frailty group (10.9 vs. 4.22 days, MD 10.9 days, 95% CI 10.52-11.28, p< 0.001) compared to the low-frailty group. Furthermore, the mean THC for 30-day readmissions for the intermediate frailty ($118,996 vs. $68, 034, MD $50962, 95% CI 48854-53069, p< 0.001) and high frailty ($195,584 vs. $68,034, MD $127550, 95% CI 120,581-134,519, p< 0.001) group was significantly higher than that of the low-frailty group.

Discussion: Increasing HFRS score was associated with increased odds of readmission following ERCP on index admission. Furthermore, patients with higher HFRS scores had longer inpatient stays and higher hospitalization charges on 30-day readmission. Hence, cautious use of ERCP in this subset population could potentially reduce readmission rates and the healthcare burden.
1.Comparison of readmission rates in frail vs non-frail admissions undergoing ERCP
 HFRS< 5 -referentHFRS 5-15OR (95% CI)p-valueHFRS > 15OR (95% CI)P-value
Readmission
Overall
 42583 (7.56%)43270 (11.17%)1.67 (1.64 - 1.71)< 0.0012477 (10.5%)1.62 (1.52 - 1.73)< 0.001
Gender
Male21076 (10.05%)21930 (13.68%)1.41 (1.37 - 1.46)< 0.0011159 (13.11%)1.34 (1.23 - 1.47)< 0.001
Female21491 (6.9%)21320 (12.4%)1.9 (1.84 - 1.96)< 0.0011316 (12.28%)1.87 (1.72 - 2.04)< 0.001
Age categories
18 - 344522 (4.6%)1725 (11.79%)2.76 (2.54 - 3.01)< 0.00135 (13.7%)3.29 (1.87 - 5.76)< 0.001
35 - 496839 (7.06%)3848 (14.43%)2.22 (2.08 - 2.36)< 0.00175 (14.52%)2.23 (1.55 - 3.22)< 0.001
50 - 6412966 (9.36%)10963 (14.63%)1.65 (1.59 - 1.72)< 0.001349 (15.37%)1.75 (1.49 - 2.07)< 0.001
65 - 7913160 (9.96%)16652 (13.18%)1.37 (1.32 - 1.42)< 0.001977 (14.4%)1.52 (1.37 - 1.68)< 0.001
≥805078 (9.44%)10061 (11.28%)1.21 (1.15 - 1.28)< 0.0011040 (10.68%)1.14 (1.03 - 1.26)0.009
Charlson Comorbidity Index (CCI)
CCI=012865 (5%)5424 (8.8%)1.84 (1.75 - 1.94)< 0.00180 (9.5%)1.99 (1.38 - 2.87)< 0.001
CCI=18168 (6.9%)6360 (10.3%)1.53 (1.45 - 1.61)< 0.001269 (10.1%)1.49 (1.25 - 1.79)< 0.001
CCI=26989 (11.94%)6679 (12.16%)1.02 (0.96 - 1.07)0.43355 (11.01%)0.91 (0.76 - 1.08)0.303
CCI≥314544 (16%)24786 (16.1%)0.95 (0.92 - 0.98)%0.0071770 (13.8%)0.79 (0.73 - 0.86)< 0.001
Insurance
Medicare19346 (10.08%)28400 (12.8%)1.31 (1.27 - 1.35)< 0.0012061 (12.4%)0.27 (1.18 - 1.36)< 0.001
Medicaid6787 (7.6%)4842 (14.76%)2.08 (1.97 - 2.2)< 0.001151 (14.09%)1.97 (1.53 - 2.55)< 0.001
Private insurance13408 (7%)7997 (13.1%)2 (1.91 - 2.09)< 0.001203 (14.14%)2.18 (1.76 - 2.7)< 0.001
Self-pay1727 (6.09%)965 (12.8%)2.26 (1.99 - 2.57)< 0.00118 (12.69%)2.23 (1.99 - 4.49)0.024
Hospital Bed Size
Metropolitan non-teaching5071 (6.765)5008 (11.59%)1.9 (1.82 - 1.99)< 0.001297 (11.61%)1.89 (1.65 - 2.17)< 0.001
Metropolitan teaching10233 (7.65)10351 (12.19%)1.61 (1.57 - 1.65)< 0.001605 (12.16%)1.54 (1.43 - 1.66)< 0.001
Non-metropolitan27263 (8.75)27891 (13.7%)1.78 (1.56 - 2.02)< 0.0011572 (13.08%)1.96 (1.34 - 2.86)0.001
2.Healthcare burden in admissions receiving ERCP
 HFRS< 5 (referent)HFRS 5-15Difference (95% CI)p-valueHFRS > 15Difference P-value
THC*68,034118,99650962 (48,854-53,069)< 0.001195,584127550 (120,581-134,519)< 0.001
LOS^4.228.494.26 (4.19-4.34)< 0.00115.1310.9 (10.52-11.28)< 0.001
3.Mortality in admissions undergoing ERCP  
 Index admissionsReadmissionsUnadjusted odds ratio 95% confidence intervalP-value  
Overall14693 (1.66%)3907 (4.42%)2.742.59 - 2.2.89< 0.001  
FRAILTY CATEGORIES  
HFRS< 5906 (0.17%)507 (1.11%)6.865.86 - 8.03< 0.001  
HFRS 5-1512021 (3.49%)3165 (7.3%)2.172.04 - 2.31< 0.001  
HFRS > 151764 (8.2%)235 (10.44%)1.291.04 - 1.60< 0.001  

Table: Part 1: Comparison of readmission rates in low, intermediate and high frailty groups.
Part 2: Comparison of length of stay and hospitalization charges in low, intermediate and high frailty groups.
Part 3: Mortality rates in admissions undergoing ERCP.


Disclosures:
Bhanu Siva Mohan Pinnam indicated no relevant financial relationships.
Dushyant Dahiya indicated no relevant financial relationships.
Saurabh Chandan indicated no relevant financial relationships.
Hassam Ali indicated no relevant financial relationships.
Manesh Kumar Gangwani indicated no relevant financial relationships.
Harishankar Gopakumar indicated no relevant financial relationships.
Ishaan Vohra indicated no relevant financial relationships.
Daksh Ahluwalia indicated no relevant financial relationships.
Jay Bapaye indicated no relevant financial relationships.
Mohammad Al-Haddad: Amplified Sciences – Grant/Research Support. Creatics, LLC – Grant/Research Support. Interpace diagnostics – Consultant.
Neil Sharma: Boston Scientific – Consultant. Mauna Kea – Consultant. Medtronic – Consultant. Olympus – Consultant. Steria – Consultant.


Bhanu Siva Mohan Pinnam, MD1, Dushyant Singh. Dahiya, MD2, Saurabh Chandan, MD3, Hassam Ali, MD4, Manesh Kumar Gangwani, MD5, Harishankar Gopakumar, MD6, Ishaan Vohra, MD6, Daksh Ahluwalia, MD1, Jay Bapaye, MBBS, MD7, Mohammad Al-Haddad, MD8, Neil Sharma, MD9. P0855 - Impact of Frailty on Early Readmissions of Endoscopic Retrograde Cholangiopancreatography in the United States, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.