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

doi:10.4253/wjge.v16.i3.148

Impact of frailty on endoscopic retrograde cholangiopancreatography outcomes in nonagenarians: A United States national experience

World J Gastrointest Endosc. 2024 Mar 16;16(3):148-156. doi: 10.4253/wjge.v16.i3.148.

Affiliations

¹ Department of Internal Medicine, University of Missouri-Columbia, Columbia, MO 65212, United States.
² Division of Gastroenterology, Hepatology & Motility, The University of Kansas School of Medicine, Kansas City, KS 66160, United States . dush.dahiya@gmail.com.
³ Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO 65212, United States.
⁴ Department of Rheumatology, Medical College of Georgia, Augusta University, North Augusta, GA 30912, United States.
⁵ Department of Internal Medicine, John H. Stroger Hospital of Cook County, Chicago, IL 60612, United States.
⁶ Department of Internal Medicine, The University of Toledo, Toledo, OH 43606, United States.
⁷ Division of Gastroenterology and Hepatology, East Carolina University/Brody School of Medicine, Greenville, NC 27858, United States.
⁸ Department of Internal Medicine, Sinai Hospital, Baltimore, MD 21215, United States.
⁹ Department of Internal Medicine, Trinity Health Oakland/Wayne State University, Pontiac, MI 48341, United States.
¹⁰ Division of Gastroenterology and Hepatology, Creighton University School of Medicine, Omaha, NE 68131, United States.
¹¹ Division of Interventional Oncology & Surgical Endoscopy, GI Oncology Tumor Site Team, Parkview Cancer Institute, Parkview Health, Fort Wayne, IN 46845, United States.
¹² Section of Gastroenterology & Hepatology, West Virginia University School of Medicine, Morgantown, WV 26505, United States.

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; Frailty; Healthcare burden; Mortality; Nonagenarians.