Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Mar 16, 2024; 16(3): 148-156
Published online Mar 16, 2024. doi: 10.4253/wjge.v16.i3.148
Impact of frailty on endoscopic retrograde cholangiopancreatography outcomes in nonagenarians: A United States national experience
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
Sanket Dhirubhai Basida, Department of Internal Medicine, University of Missouri-Columbia, Columbia, MO 65212, United States
Dushyant Singh Dahiya, Division of Gastroenterology, Hepatology & Motility, The University of Kansas School of Medicine, Kansas City, KS 66160, United States
Muhammad Nadeem Yousaf, Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO 65212, United States
Brinda Basida, Department of Rheumatology, Medical College of Georgia, Augusta University, North Augusta, GA 30912, United States
Bhanu Siva Mohan Pinnam, Daksh Ahluwalia, Mihir Prakash Shah, Department of Internal Medicine, John H. Stroger Hospital of Cook County, Chicago, IL 60612, United States
Manesh Kumar Gangwani, Department of Internal Medicine, The University of Toledo, Toledo, OH 43606, United States
Hassam Ali, Division of Gastroenterology and Hepatology, East Carolina University/Brody School of Medicine, Greenville, NC 27858, United States
Sahib Singh, Department of Internal Medicine, Sinai Hospital, Baltimore, MD 21215, United States
Yash R Shah, Department of Internal Medicine, Trinity Health Oakland/Wayne State University, Pontiac, MI 48341, United States
Saurabh Chandan, Division of Gastroenterology and Hepatology, Creighton University School of Medicine, Omaha, NE 68131, United States
Neil R Sharma, Division of Interventional Oncology & Surgical Endoscopy, GI Oncology Tumor Site Team, Parkview Cancer Institute, Parkview Health, Fort Wayne, IN 46845, United States
Shyam Thakkar, Section of Gastroenterology & Hepatology, West Virginia University School of Medicine, Morgantown, WV 26505, United States
Co-first authors: Sanket Dhirubhai Basida and Dushyant Singh Dahiya.
Author contributions: Basida SD, Dahiya DS, and Yousaf MN contributed to conception and design; Basida SD, Ali H, Ahluwalia D, Shah MP, and Singh S contributed to administrative support; Basida SD, Basida B, Shah YR, Pinnam BSM, Ahluwalia D, Shah MP, Ali H, Gangwani MK, Chandan S, and Dahiya DS contributed to provision, collection, and assembly of data; Basida SD, Yousaf MN, Dahiya DS, Ali H, Gangwani MK, Chandan S, Basida B, Shah YR, Pinnam BSM, Singh S, Sharma NR, and Thakkar S contributed to the review of the literature and drafting the manuscript; Basida SD, Yousaf MN, Dahiya DS, Chandan S, Sharma NR, and Thakkar S contributed to revision of key components of the manuscript and final approval of manuscript; Basida SD, Yousaf MN, Dahiya DS, Basida B, Pinnam BSM, Gangwani MK, Ali H, Singh S, Shah YR, Ahluwalia D, Shah MP, Chandan S, Sharma NR and Thakkar S are accountable for all aspects of the work.
Institutional review board statement: This study, utilizing the National (or Nationwide) Readmission Database (NRD), is exempt from full Institutional Review Board (IRB) review as it involves secondary analysis of de-identified data collected for administrative purposes. The exemption is granted by federal regulations governing research involving publicly available data and poses minimal risk to subjects, maintaining their anonymity. No identifiable information was used, ensuring strict confidentiality. This exemption aligns with ethical standards and guidelines.
Informed consent statement: This letter is to confirm that our study did not require informed consent as it did not contain de-identified.
Conflict-of-interest statement: The authors have no financial relationships or conflicts of interest to disclose.
Data sharing statement: Not available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dushyant Singh Dahiya, MD, Doctor, Division of Gastroenterology, Hepatology & Motility, The University of Kansas School of Medicine, 2000 Olathe Blvd, Kansas City, KS 66160, United States. dush.dahiya@gmail.com
Received: December 23, 2023
Peer-review started: December 23, 2023
First decision: January 11, 2024
Revised: January 19, 2024
Accepted: February 23, 2024
Article in press: February 23, 2024
Published online: March 16, 2024
Processing time: 81 Days and 14.9 Hours
Abstract
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 insignificant 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 warranted to investigate and mitigate modifiable risk factors.

Keywords: Endoscopic retrograde cholangiopancreatography; Nonagenarians; Frailty; Mortality; Healthcare burden

Core Tip: In this comprehensive national study, frail nonagenarians undergoing endoscopic retrograde cholangiopancreatography (ERCP) faced heightened mortality, prolonged hospital stays, and increased healthcare costs compared to non-frail counterparts. Surprisingly, intra-procedural and post-procedural complications showed no significant difference between the frail and non-frail groups, including bleeding and accidental punctures. Notably, post-ERCP pancreatitis rates were also comparable. Despite similar 30 d readmission rates, frailty emerged as an independent predictor of post-ERCP mortality in nonagenarians. With limited guidelines for such advanced procedures in this population, careful consideration of benefits vs risks is crucial, urging a personalized approach for those with approved indications for ERCP.