Biliary Drainage Method and Temporal Trends in Patients Admitted with Cholangitis: A National Audit. (2013)

• Record Type: Journal Article
• Authors: McNabb-Baltar, Julia; Trinh, Quoc-Dien; Barkun, Alan N
• Is Part Of: Canadian Journal of Gastroenterology. Volume 27:Number 9(2013)
• Page Start: 513
• Page End: 518
• Publication Date: 2013
• Subjects: Cholangitis -- Endoscopic retrograde cholangiopancreatography (ERCP) -- Nationwide Inpatient Sample (NIS)
• DOI: 10.1155/2013/175143
• Languages: English
• ISSNs: 0835-7900

Abstract

Abstract : BACKGROUND: In patients presenting with ascending cholangitis, better outcomes are reported in those undergoing endoscopic retrograde cholangiopancreatography (ERCP) compared with surgical drainage. OBJECTIVE: To identify factors associated with the type of intervention, and to examine temporal trends in the treatment of ascending cholangitis. METHODS: Data were extracted from the Nationwide Inpatient Sample. Patients ≥18 years of age with a diagnosis of cholangitis between 1998 and 2009 were selected. Temporal trends were assessed using Poisson regression models. Multivariable models were fitted to predict the likelihood of a patient undergoing ERCP, percutaneous or surgical drainage, or no drainage. RESULTS: A weighted estimate of 248, 942 patients admitted for cholangitis was identified. Overall, 131, 052 patients were treated with ERCP (52.6%), 10, 486 with percutaneous drainage (4.2%) and 12, 460 with surgical drainage (5.0%); 43.0% did not receive drainage during the admission. Temporal trends between 1998 and 2009 showed a decline in surgical and percutaneous drainage, and a rise in ERCP. In multivariable analyses adjusted for clustering, ERCP and percutaneous drainage were more often performed in institutions with a high volume of admissions for cholangitis, those with a greater bed number and hospitals located in urban areas. CONCLUSION: Over the past decade, the use of surgical and percutaneous drainage has decreased while that of ERCP has risen. Patients treated at institutions with a low volume of admissions for cholangitis, small bed number and in rural areas were less likely to undergo ERCP or percutaneous drainage.