Big-data analysis: A clinical pathway on endoscopic retrograde cholangiopancreatography for common bile duct stones

doi:10.3748/wjg.v25.i8.1002

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Gastroenterol. Feb 28, 2019; 25(8): 1002-1011
Published online Feb 28, 2019. doi: 10.3748/wjg.v25.i8.1002

Table 1 Demographic and clinical characteristics of patients

Characteristic	Non-pathway group (n = 467)	Cinical pathway group (n = 2196)	P value
Age, yr (median, range)	64 (52-75)	63 (51-75)	0.405
Female, n (%)	235 (50.32)	1093 (49.77)	0.829
Medical insurance, n (%)	217 (46.47)	945 (43.03)	0.174
Health behavior, n (%)
Smoking	57 (12.21)	260 (11.84)	0.825
Alcohol use	36 (7.71)	164 (7.47)	0.858
Comorbidity, n (%)
Hypertension	155 (33.19)	703 (32.01)	0.621
Diabetes	68 (14.56)	292 (13.30)	0.468
COPD	11 (2.36)	54 (2.46)	0.895
Myocardial infarction	0	6 (0.27)	0.258
Cholangitis	74 (15.85)	271 (12.34)	0.041^a
Cholecystolithiasis	188 (40.26)	780 (35.52)	0.053
JPD	1 (0.21)	10 (0.46)	0.460
CBD stone number ≥ 5, n (%)	201 (43.04)	1173 (53.42)	< 0.001^a
Maximum diameter of stones, cm (median, range)	0.8 (0.6-1.2)	0.9 (0.6-1.2)	0.949
Laboratory test (median, range)
Temperature (°C), n = 359/2113	36.5 (36.3-36.8)	36.5 (36.3-36.8)	0.855
WBC count, n = 370/1451	6.0 (4.7-9.2)	5.7 (4.6-7.6)	0.005^a
Direct bilirubin level, n = 363/1439	12.2 (5.6-44.2)	10.7 (4.8-37.2)	0.210
Total bilirubin level, n = 363/1439	22.6 (12.7-57.6)	21.2 (12.5-51.9)	0.628
AST, n = 363/1440	47.9 (22.8-104.5)	45.4 (23.5-104.8)	0.842
GGT, n = 363/1439	257.4 (115.3-492.4)	265.1 (109.9-519.4)	0.918
ALP, n = 363/1439	161.7 (99.9-283.3)	154.9 (97.4-259.3)	0.536
ALT, n = 364/1443	85.1 (29.6-203.2)	89.0 (32.0-206.9)	0.946
Cr, n = 361/1431	62.0 (52.0-74.0)	62.0 (2.0-73.0)	0.966

^aP < 0.05 was considered statistically significant.

COPD: Chronic obstructive pulmonary disease; JPD: Juxtapapillary duodenal diverticulum; CBD stones: Common bile duct stones; WBC: White blood cell; AST: Aspartate transaminase; GGT: Gamma-glutamyl transpeptidase; ALP: Alkaline phosphatase; Cr: Creatinine.

Table 2 Comparison of length of hospital stay, clinical outcomes, hospital charges, and drug use between the non-pathway and clinical pathway groups

Characteristic	Non-pathway group (n = 467)	Cinical pathway group (n = 2196)	P value
Length of total hospital stay (median, range)	8 (6-11)	7 (5-9)	< 0.001^a
Pre-operative length of stay	2 (1-4)	2 (1-3)	0.451
Readmission, n (%)	34 (7.28)	173 (7.88)	0.661
Clinical outcomes, n (%)			0.115
Recovered	223 (47.75)	1146 (52.19)
Improved	236 (50.54)	1028 (46.81)
Not improved	8 (1.71)	22 (1)
Died	0	0
Charges of hospitalization (CNY), (median, range) n = 467/2183	21508.3 (17150.6-30045.8)	18362.9 (15665.8-22895.2)	< 0.001^a
Charges of medication, n = 459/2153	6620.6 (3429.4-12239.7)	4900.6 (3172.4-8186.0)	< 0.001^a
Charges of operation, n = 458/2151	5741.0 (4519.2-7324.0)	5455.2 (2670.0-6964.0)	< 0.001^a
Charges of nursing, n = 454/2133	188.0 (115.0-288.0)	120.0 (74.0-211.0)	< 0.001^a
Charges of materials, n = 409/1540	7916.4 (6696.0-10552.6)	6985.5 (6135.1-8224.7)	< 0.001^a
Charges of examination, n = 459/2153	2698.0 (2224.5-3799.5)	2463.5 (2134.5-3105.5)	< 0.001^a
Antibiotic use, n (%)	260/430 (60.47)	832/1737 (47.90)	< 0.001^a
Antibiotic usage duration (d) (median, range), n = 260/832	12 (8.0-18.5)	11 (7.0-17.0)	0.004^a
Three line antibiotic use, n (%)	51/430 (11.86)	149/1737 (8.58)	0.035^a
Secondary surgery, n (%)	69 (14.78)	372 (16.94)	0.253

^aP < 0.05 was considered statistically significant.

Table 3 Comparison of postoperative complication rates between the non-pathway and clinical pathway groups

Characteristic	Non-pathway group (n = 467)	Cinical pathway group (n = 2196)	P value
Total, n (%)	125 (26.77)	316 (14.39)	< 0.001^a
Acute pancreatitis	113 (24.20)	298 (13.57)	< 0.001^a
Gallbladder perforation	1 (0.21)	1 (0.05)	0.227
Gastrointestinal hemorrhage	0	2 (0.09)	0.514
Biliary tract infection	2 (0.43)	4 (0.18)	0.308
Liver abscess	10 (2.14)	11 (0.50)	< 0.001^a

^aP < 0.05 was considered statistically significant.

Table 4 Univariate logistic regression analysis of outcomes

Characteristic	Non-pathway group (n = 467)	Cinical pathway group (n = 2196)	OR (95%CI)		P value
Length of total hospital stay (median, range)	8 (6-11)	7 (5-9)			< 0.001^a
Pre-operative length of stay	2 (1-4)	2 (1-3)			0.078
Readmission, n (%)	34 (7.28)	173 (7.88)	1.09 (0.74, 1.60)		0.661
Clinical outcomes, n (%)			1.21 (0.99, 1.47)		0.064
Charges of hospitalization (CNY) (median, range)	21508.3 (17150.6-30045.8)	18362.9 (15665.8-22895.2)			< 0.001^a
Medication	6620.6 (3429.4-12239.7)	4900.6 (3172.4-8186.0)			< 0.001^a
Operating	5741.0 (4519.2-7324.0)	5455.2 (2670.0-6964.0)			< 0.001^a
Nursing	188.0 (115.0-288.0)	120.0 (74.0-211.0)			< 0.001^a
Materials	7916.4 (6696.0-10552.6)	6985.5 (6135.1-8224.7)			< 0.001^a
Examination	2698.0 (2224.5-3799.5)	2463.5 (2134.5-3105.5)			< 0.001^a
Antibiotic use, n (%)	260/430 (60.47)	832/1737(47.90)	0.60 (0.49, 0.75)		< 0.001^a
Antibiotic usage duration (d) (median, range)	12 (8.0-18.5)	11 (7.0-17.0)			0.310
Three line antibiotic use, n (%)	51/430 (11.86)	149/1437 (8.58)		0.69	0.036^a
Secondary surgery, n (%)	69 (14.78)	372 (16.94)		1.18	0.254
Complications	125 (26.77)	316 (14.39)		0.46 (0.36, 0.58)	< 0.001^a

^aP < 0.05 was considered statistically significant. OR: Odds ratio; CI: Confidence interval.

Table 5 Multivariate logistic and linear regression analysis of outcomes

Characteristic	Adjusted OR (95%CI) or coefficients	P value
Length of total hospital stay	-1.71 (-2.30, -1.12)¹	< 0.001^a
Hospitalization costs	-5572.26 (-6931.48, -4213.03)¹	< 0.001^a
Medication costs	-2760.03 (-3738.96, -1781.11)¹	< 0.001^a
Operating costs	-382.08 (-635.30, -128.85)¹	< 0.001^a
Nursing costs	-138.25 (-195.83, -80.66)¹	< 0.001^a
Materials costs	-1688.35 (-2049.61, -1327.10)¹	< 0.001^a
Examination costs	-138.25 (-195.83, -80.66)¹	< 0.001^a
Three line antibiotic use	0.89 (0.60, 1.31)	0.546
Antibiotic use, n (%)	0.72 (0.55, 0.93)	0.012^a
Complications	0.44 (0.33, 0.59)	< 0.001^a

¹Coefficients.

^aP < 0.05 was considered statistically significant, adjusted for age, gender, smoking, alcohol use, the number of stones, and white blood cell count at hospital admission.

OR: Odds ratio; CI: Confidence interval.

Citation: Zhang W, Wang BY, Du XY, Fang WW, Wu H, Wang L, Zhuge YZ, Zou XP. Big-data analysis: A clinical pathway on endoscopic retrograde cholangiopancreatography for common bile duct stones. World J Gastroenterol 2019; 25(8): 1002-1011
URL: https://www.wjgnet.com/1007-9327/full/v25/i8/1002.htm
DOI: https://dx.doi.org/10.3748/wjg.v25.i8.1002