Endoscopic retrograde cholangiopancreatography-associated pancreatitis:incidence,and risk factors analysis based on the nationwide inpatient sample database in the US
Objective To investigate the incidence of post-ERCP pancreatitis(PEP)and its risk factors based on a large sam-ple size,in order to implement targeted perioperative management,reduce surgical complications,and promote patient out-comes.Methods By querying the US National Inpatient Sample(NIS)database,adult patients who underwent ERCP from 2010 to 2019 were identified using the International Classification of Diseases,Ninth Revision(ICD-9)and Tenth Revision(ICD-10)procedural codes.Patients meeting the inclusion criteria were divided into PEP and non-PEP groups based on the occurrence of PEP.Patient demographic characteristics,hospital characteristics,length of hospital stay,related economic indicators,and in-hospital mortality rates were assessed using rank sum tests and chi-square tests.Multivariate logistic re-gression analysis was used to analyze factors associated with the occurrence of PEP.Results A total of 337 515 patients who underwent ERCP were identified,with 15 148 cases of PEP,resulting in an incidence of 4.49%.The proportion of male patients in the PEP group was significantly higher than that in the non-PEP group(44.32%vs.41.59%;P<0.05).The distribution of different ethnicities in the PEP and non-PEP groups was statistically significant(P<0.05).The in-hos-pital mortality rate for patients in the PEP group was significantly higher than that in the non-PEP group(3.60%vs.1.33%;P<0.05).Additionally,the occurrence of PEP increased the median length of hospital stay significantly by 3 days(P<0.05);meanwhile,the median total hospitalization cost for patients in the PEP group was $ 22 795 higher than that for patients in the non-PEP group(P<0.05).Logistic regression results showed that the use of Medicaid payment(OR=1.16),urban hospitals(OR=1.40),preoperative acquired immunodeficiency syndrome(OR=1.87),preoperative alcohol abuse(OR=1.38),preoperative iron-deficiency anemia(OR=1.12),preoperative congestive heart failure(OR=1.26),preoperative coagulation disorders(OR=1.33),preoperative fluid and electrolyte disorders(OR=1.58),preoperative oth-er neurological diseases(OR=1.28),preoperative obesity(OR=1.16),preoperative paralysis(OR=1.30),and preopera-tive renal failure(OR=1.25)were risk factors for the occurrence of PEP among them(P<0.05).Conclusion The overall incidence of PEP in patients undergoing ERCP remains high and causes adverse outcomes in the US.Identifying risk factors for PEP can help formulate appropriate perioperative management plans for patients undergoing ERCP,thereby further im-proving patient outcomes.