Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website https://www.gastrores.org

Original Article

Volume 15, Number 6, December 2022, pages 314-324

Expanding the Use of Endoscopic Retrograde Cholangiopancreatography in Pediatrics: A National Database Analysis of Demographics and Complication Rates

Figure 1. ICD10 procedure codes used to identify an ERCP during a hospitalization. Presenting diagnoses are provided by the KID for each individual hospitalization. Also shown are the codes used to define complication associated with performed ERCP. *A diagnosis code for pancreatitis was captured as a complication if the diagnosis code was entered within 24 h of the documented ERCP. ERCP: endoscopic retrograde cholangiopancreatography; KID: Kids’ Inpatient Database.

Figure 2. Differences in admission primary diagnosis between genders. Females had statistically higher rates of calculus of the gallbladder/bile duct (P = 0.03) and chronic cholecystitis (P = 0.02). Males had higher rates of traumatic injury (P < 0.001), obstruction of the bile duct (P < 0.001), cholangitis (P = 0.002), and primary sclerosing cholangitis (P = 0.02).

**Table 1.** Overall Clinical and Demographic Characteristics of Patients From the 2016 Kids’ Inpatient Database
Characteristics	Values
Over 6 million hospitalizations were included in the overall sample, and we restricted the query to live births with at least one ERCP, giving n = 4,484 for ages 0 to 20 and n = 1,934 for ages 0 to 17. A large percentage of the captured patients came from the older age groups, indicating that this is an uncommon procedure in patients age ≤ 10. ERCP: endoscopic retrograde cholangiopancreatography.
Total admissions	4,484
Gender
Male	1,006 (22.47%)
Female	3,478 (77.53%)
Complication rate	242 (5.41%)
Median length of stay (days)
Male	4
Female	3
In-hospital mortality	0.20%
Age
0 - 5	183 (4.09%)
6 - 10	197 (4.40%)
11 - 15	740 (16.51%)
16 - 20	3,364 (75.00%)
Total	4,484
Race
White	1,792 (39.97%)
Black	559 (12.49%)
Hispanic	1,483 (33.09%)
Asian/Pacific Islander	81 (1.82%)
Native American	68 (1.53%)
Other	232 (5.19%)
Region
Northeast	649 (14.48%)
Midwest	779 (17.39%)
South	1,826 (40.73%)
West	1,228 (27.39%)
Presenting diagnosis frequency
Traumatic injury or organ laceration	89 (2.00%)
Sepsis	60 (1.35%)
Acute pancreatitis	487 (10.86%)
Chronic pancreatitis	59 (1.33%)
Obstruction of bile duct	99 (2.23%)
Cholangitis	166 (3.71%)
Calculus of gallbladder/bile duct	1,015 (22.64%)
Chronic cholecystitis	346 (7.72%)
Acute cholecystitis	1,223 (27.29%)
Primary sclerosing cholangitis	91 (2.03%)
Malignancy/tumor	56 (1.26%)
Retained stones after cholecystectomy	102 (2.28%)
Procedural complication	108 (2.43%)
ERCP number
1	3,137 (69.97%)
2	1,172 (26.15%)
3	139 (3.11%)
4	25 (0.56%)
> 5	≤ 10

Table 1. Overall Clinical and Demographic Characteristics of Patients From the 2016 Kids’ Inpatient Database

Characteristics

Values

Over 6 million hospitalizations were included in the overall sample, and we restricted the query to live births with at least one ERCP, giving n = 4,484 for ages 0 to 20 and n = 1,934 for ages 0 to 17. A large percentage of the captured patients came from the older age groups, indicating that this is an uncommon procedure in patients age ≤ 10. ERCP: endoscopic retrograde cholangiopancreatography.

Total admissions

4,484

Gender

Male

1,006 (22.47%)

Female

3,478 (77.53%)

Complication rate

242 (5.41%)

Median length of stay (days)

Male

Female

In-hospital mortality

0.20%

Age

0 - 5

183 (4.09%)

6 - 10

197 (4.40%)

11 - 15

740 (16.51%)

16 - 20

3,364 (75.00%)

Total

4,484

Race

White

1,792 (39.97%)

Black

559 (12.49%)

Hispanic

1,483 (33.09%)

Asian/Pacific Islander

81 (1.82%)

Native American

68 (1.53%)

Other

232 (5.19%)

Region

Northeast

649 (14.48%)

Midwest

779 (17.39%)

South

1,826 (40.73%)

West

1,228 (27.39%)

Presenting diagnosis frequency

Traumatic injury or organ laceration

89 (2.00%)

Sepsis

60 (1.35%)

Acute pancreatitis

487 (10.86%)

Chronic pancreatitis

59 (1.33%)

Obstruction of bile duct

99 (2.23%)

Cholangitis

166 (3.71%)

Calculus of gallbladder/bile duct

1,015 (22.64%)

Chronic cholecystitis

346 (7.72%)

Acute cholecystitis

1,223 (27.29%)

Primary sclerosing cholangitis

91 (2.03%)

Malignancy/tumor

56 (1.26%)

Retained stones after cholecystectomy

102 (2.28%)

Procedural complication

108 (2.43%)

ERCP number

3,137 (69.97%)

1,172 (26.15%)

139 (3.11%)

25 (0.56%)

> 5

≤ 10

**Table 2.** ERCP Age Group Comparison
Characteristics	Age (frequency (%))	P-value
The common primary diagnoses for age ≤ 5 were acute pancreatitis, obstruction of the bile duct, cholangitis, and malignancy/tumor. This contrasts with the older age groups which had higher rates of acute cholecystitis and calculus of the gallbladder. Patients ≤ 5 were more frequently White or Black, and age > 10 were more often Hispanic. There was no statistical difference in rates of repeat procedure or complication between age groups. ERCP: endoscopic retrograde cholangiopancreatography.
Routine discharge	161 (89.6%)	181 (92.3%)	705 (95.5%)	3,223 (95.9%)	< 0.001
Facility transfer, home health, AMA, in-hospital mortality	17 (9.3%)	14 (6.6%)	32 (4.3%)	137 (4.1%)
Median length of stay	6	5	4	3	< 0.001
Procedural complications	14 (7.9%)	≤ 10	36 (5%)	181 (5.4%)	0.68
Race
White	86 (51.5%)	72 (41.8%)	276 (41%)	1,356 (42.4%)
Black	31 (19%)	29 (16.7%)	102 (15.2%)	396 (12.4%)
Hispanic	29 (17.7%)	50 (29.1%)	225 (33.4%)	1,178 (36.8%)
Asian/Pacific Islander	≤ 10	12 (7%)	≤ 10	52 (1.6%)
Native American	≤ 10	≤ 10	18 (2.8%)	47 (1.5%)
Other	≤ 10	≤ 10	42 (6.3%)	171 (5.3%)
Diagnosis
Traumatic injury or organ laceration	≤ 10	15 (7.8%)	18 (2.6%)	47 (1.4%)	< 0.001
Sepsis	≤ 10	≤ 10	≤ 10	52 (1.6%)	0.1
Acute pancreatitis	30 (16.8%)	29 (14.8%)	96 (13%)	330 (9.8%)	0.001
Chronic pancreatitis	≤ 10	≤ 10	28 (3.8%)	16 (0.5%)	< 0.001
Obstruction of bile duct	18 (10.1%)	11 (5.7%)	15 (2.1%)	55 (1.6%)	< 0.001
Cholangitis	12 (6.8%)	≤ 10	41 (5.6%)	103 (3.1%)	0.003
Calculus of gallbladder/bile duct	27 (14.8%)	47 (24%)	205 (27.8%)	734 (21.9%)	0.27
Chronic cholecystitis	≤ 10	15 (7.8%)	58 (7.8%)	270 (8%)	0.19
Acute cholecystitis	≤ 10	13 (7.1%)	153 (20.8%)	1,047 (31.1%)	< 0.001
Primary sclerosing cholangitis	≤ 10	≤ 10	26 (3.6%)	53 (1.6%)	0.01
Malignancy/tumor	15 (8.3%)	≤ 10	13 (1.9%)	23 (0.7%)	< 0.001
Retained stones after cholecystectomy	≤ 10	≤ 10	14 (2%)	86 (2.6%)	0.05
Procedural complication	≤ 10	≤ 10	17 (2.4%)	82 (2.5%)	0.83
Repeat ERCP
No	118 (64.9%)	142 (72.1%)	505 (68.2%)	2,371 (70.5%)	0.27
Yes	64 (35.1%)	55 (27.9%)	235 (31.8%)	992 (29.5%)

Table 2. ERCP Age Group Comparison

Characteristics

Age (frequency (%))

P-value

0 - 5 (n = 183)

6 - 10 (n = 197)

11 - 15 (n = 740)

16 - 20 (n = 3,363)

The common primary diagnoses for age ≤ 5 were acute pancreatitis, obstruction of the bile duct, cholangitis, and malignancy/tumor. This contrasts with the older age groups which had higher rates of acute cholecystitis and calculus of the gallbladder. Patients ≤ 5 were more frequently White or Black, and age > 10 were more often Hispanic. There was no statistical difference in rates of repeat procedure or complication between age groups. ERCP: endoscopic retrograde cholangiopancreatography.

Routine discharge

161 (89.6%)

181 (92.3%)

705 (95.5%)

3,223 (95.9%)

< 0.001

Facility transfer, home health, AMA, in-hospital mortality

17 (9.3%)

14 (6.6%)

32 (4.3%)

137 (4.1%)

Median length of stay

< 0.001

Procedural complications

14 (7.9%)

≤ 10

36 (5%)

181 (5.4%)

0.68

Race

White

86 (51.5%)

72 (41.8%)

276 (41%)

1,356 (42.4%)

Black

31 (19%)

29 (16.7%)

102 (15.2%)

396 (12.4%)

Hispanic

29 (17.7%)

50 (29.1%)

225 (33.4%)

1,178 (36.8%)

Asian/Pacific Islander

≤ 10

12 (7%)

≤ 10

52 (1.6%)

Native American

≤ 10

18 (2.8%)

47 (1.5%)

Other

≤ 10

42 (6.3%)

171 (5.3%)

Diagnosis

Traumatic injury or organ laceration

≤ 10

15 (7.8%)

18 (2.6%)

47 (1.4%)

< 0.001

Sepsis

≤ 10

52 (1.6%)

0.1

Acute pancreatitis

30 (16.8%)

29 (14.8%)

96 (13%)

330 (9.8%)

0.001

Chronic pancreatitis

≤ 10

28 (3.8%)

16 (0.5%)

< 0.001

Obstruction of bile duct

18 (10.1%)

11 (5.7%)

15 (2.1%)

55 (1.6%)

< 0.001

Cholangitis

12 (6.8%)

≤ 10

41 (5.6%)

103 (3.1%)

0.003

Calculus of gallbladder/bile duct

27 (14.8%)

47 (24%)

205 (27.8%)

734 (21.9%)

0.27

Chronic cholecystitis

≤ 10

15 (7.8%)

58 (7.8%)

270 (8%)

0.19

Acute cholecystitis

≤ 10

13 (7.1%)

153 (20.8%)

1,047 (31.1%)

< 0.001

Primary sclerosing cholangitis

≤ 10

26 (3.6%)

53 (1.6%)

0.01

Malignancy/tumor

15 (8.3%)

≤ 10

13 (1.9%)

23 (0.7%)

< 0.001

Retained stones after cholecystectomy

≤ 10

14 (2%)

86 (2.6%)

0.05

Procedural complication

≤ 10

17 (2.4%)

82 (2.5%)

0.83

Repeat ERCP

118 (64.9%)

142 (72.1%)

505 (68.2%)

2,371 (70.5%)

0.27

Yes

64 (35.1%)

55 (27.9%)

235 (31.8%)

992 (29.5%)

**Table 3.** Gender Comparison
Characteristics	Gender (frequency (%))	Odds ratio	95% CI	P-value
Over three-fourths of the ERCPs performed in this dataset occurred in females. Here we see the increased rates of complication and decreased rate of home discharge seen in the male population which was proportionally younger than the female population. Males were also seen to have extended lengths of stay and increased frequency of multiple ERCPs during hospitalization. Presenting diagnoses differed dramatically between genders. ERCP: endoscopic retrograde cholangiopancreatography.
Postprocedural complications	173 (5%)	68 (6.9%)	0.71	(0.514, 0.988)	0.04
Median length of stay (days)	3	4			< 0.001
Repeat ERCP rate	1,019 (29.3%)	324 (32.4%)			0.098
Routine home discharge	3,350 (96.5%)	920 (91.9%)			0.001
Facility transfer, home health, AMA, in-hospital mortality	128 (3.5%)	82 (8.1%)
Diagnosis
Traumatic injury or organ laceration	29 (0.9%)	59 (6%)	0.14	(0.077, 0.2)	< 0.001
Sepsis	30 (0.9%)	30 (3.1%)	0.28	(0.144, 0.5)	< 0.001
Acute pancreatitis	365 (10.5%)	121 (12.1%)	0.85	(0.654, 1.1)	0.23
Chronic pancreatitis	34 (1%)	24 (2.5%)	0.39	(0.187, 0.8)	0.01
Obstruction of bile duct	51 (1.5%)	48 (4.9%)	0.29	(0.196, 0.4)	< 0.001
Cholangitis	76 (2.2%)	89 (9%)	0.23	(0.151, 0.3)	< 0.001
Calculus of gallbladder/bile duct	842 (24.2%)	173 (17.3%)	1.53	(1.213, 1.9)	< 0.001
Chronic cholecystitis	292 (8.4%)	53 (5.4%)	1.62	(1.145, 2.3)	0.006
Acute cholecystitis	1,017 (29.3%)	205 (20.5%)	1.6	(1.311, 2)	< 0.001
Primary sclerosing cholangitis	34 (1%)	56 (5.6%)	0.17	(0.095, 0.3)	< 0.001
Malignancy/tumor	35 (1%)	19 (1.9%)	0.54	(0.232, 1.2)	0.15
Retained stones after cholecystectomy	83 (2.4%)	19 (1.9%)	1.25	(0.698, 2.2)	0.46
Procedural complication	78 (2.3%)	30 (3%)	0.75	(0.463, 1.2)	0.23
ERCP number
1	2,459 (70.7%)	678 (67.6%)			0.004
2	904 (26%)	265 (26.4%)
3	98 (2.8%)	41 (4.1%)
4	13 (0.4%)	11 (1.1%)
5	≤ 10	≤ 10
6	≤ 10	≤ 10

Table 3. Gender Comparison

Characteristics

Gender (frequency (%))

Odds ratio

95% CI

P-value

Female (n = 3,478)

Male (n = 1,002)

Over three-fourths of the ERCPs performed in this dataset occurred in females. Here we see the increased rates of complication and decreased rate of home discharge seen in the male population which was proportionally younger than the female population. Males were also seen to have extended lengths of stay and increased frequency of multiple ERCPs during hospitalization. Presenting diagnoses differed dramatically between genders. ERCP: endoscopic retrograde cholangiopancreatography.

Postprocedural complications

173 (5%)

68 (6.9%)

0.71

(0.514, 0.988)

0.04

Median length of stay (days)

< 0.001

Repeat ERCP rate

1,019 (29.3%)

324 (32.4%)

0.098

Routine home discharge

3,350 (96.5%)

920 (91.9%)

0.001

Facility transfer, home health, AMA, in-hospital mortality

128 (3.5%)

82 (8.1%)

Diagnosis

Traumatic injury or organ laceration

29 (0.9%)

59 (6%)

0.14

(0.077, 0.2)

< 0.001

Sepsis

30 (0.9%)

30 (3.1%)

0.28

(0.144, 0.5)

< 0.001

Acute pancreatitis

365 (10.5%)

121 (12.1%)

0.85

(0.654, 1.1)

0.23

Chronic pancreatitis

34 (1%)

24 (2.5%)

0.39

(0.187, 0.8)

0.01

Obstruction of bile duct

51 (1.5%)

48 (4.9%)

0.29

(0.196, 0.4)

< 0.001

Cholangitis

76 (2.2%)

89 (9%)

0.23

(0.151, 0.3)

< 0.001

Calculus of gallbladder/bile duct

842 (24.2%)

173 (17.3%)

1.53

(1.213, 1.9)

< 0.001

Chronic cholecystitis

292 (8.4%)

53 (5.4%)

1.62

(1.145, 2.3)

0.006

Acute cholecystitis

1,017 (29.3%)

205 (20.5%)

1.6

(1.311, 2)

< 0.001

Primary sclerosing cholangitis

34 (1%)

56 (5.6%)

0.17

(0.095, 0.3)

< 0.001

Malignancy/tumor

35 (1%)

19 (1.9%)

0.54

(0.232, 1.2)

0.15

Retained stones after cholecystectomy

83 (2.4%)

19 (1.9%)

1.25

(0.698, 2.2)

0.46

Procedural complication

78 (2.3%)

30 (3%)

0.75

(0.463, 1.2)

0.23

ERCP number

2,459 (70.7%)

678 (67.6%)

0.004

904 (26%)

265 (26.4%)

98 (2.8%)

41 (4.1%)

13 (0.4%)

11 (1.1%)

≤ 10

**Table 4.** Hispanic vs. White Race Comparison
Characteristics	Race (frequency (%))	Odds ratio	95% CI	P-value
Differences between the two largest patient racial demographics, Hispanics and non-Hispanic whites (NHW) are depicted. The lower rate of complication observed in the Hispanic population can be attributed to the increased rate of acute cholecystitis, a diagnosis associated with low rates of complication. Though not statistically significant, a trend can be seen between non-Hispanic whites and repeat ERCP. Rates of interfacility transfer, home health discharge, discharge against medical advice, and in-hospital mortality also appeared to be higher in this group. ERCP: endoscopic retrograde cholangiopancreatography.
Postprocedural complications	65 (4.4%)	126 (7.1%)	0.61	(0.425, 0.881)	0.008
Median length of stay (days)	4	3			0.23
Repeat ERCP rate	412 (27.8%)	556 (31%)			0.096
Routine home discharge	1,428 (96.3%)	1,702 (95.0%)
Facility transfer, home health, AMA, in-hospital mortality	55 (3.7%)	90 (5.0%)
Diagnosis
Traumatic injury or organ laceration	13 (0.9%)	48 (2.7%)	0.34	(0.168, 0.7)	0.002
Sepsis	17 (1.2%)	25 (1.4%)	0.85	(0.403, 1.8)	0.66
Acute pancreatitis	150 (10.1%)	209 (11.7%)	0.86	(0.644, 1.1)	0.28
Chronic pancreatitis	20 (1.4%)	22 (1.2%)	1.11	(0.596, 2.1)	0.74
Obstruction of bile duct	23 (1.6%)	33 (1.9%)	0.84	(0.438, 1.6)	0.59
Cholangitis	27 (1.8%)	72 (4%)	0.44	(0.242, 0.8)	0.008
Calculus of gallbladder/bile duct	317 (21.4%)	394 (22%)	0.96	(0.781, 1.2)	0.74
Chronic cholecystitis	122 (8.3%)	136 (7.6%)	1.09	(0.818, 1.5)	0.55
Acute cholecystitis	503 (33.9%)	443 (24.8%)	1.56	(1.289, 1.9)	< 0.001
Primary sclerosing cholangitis	≤ 10	40 (2.2%)	0.27	(0.11, 0.7)	0.005
Malignancy/tumor	15 (1%)	29 (1.6%)	0.62	(0.28, 1.4)	0.24
Retained stones after cholecystectomy	28 (1.9%)	45 (2.5%)	0.75	(0.424, 1.3)	0.34
Procedural complication	22 (1.5%)	62 (3.5%)	0.41	(0.232, 0.7)	0.003
ERCP number
0	1,071 (72.2%)	1,236 (69%)			0.054
1	367 (24.7%)	484 (27%)
2	36 (2.5%)	56 (3.1%)
3	≤ 10	11 (0.6%)
4	≤ 10	≤ 10

Table 4. Hispanic vs. White Race Comparison

Characteristics

Race (frequency (%))

Odds ratio

95% CI

P-value

Hispanic (n = 1,483)

Non-Hispanic White (n = 1,792)

Differences between the two largest patient racial demographics, Hispanics and non-Hispanic whites (NHW) are depicted. The lower rate of complication observed in the Hispanic population can be attributed to the increased rate of acute cholecystitis, a diagnosis associated with low rates of complication. Though not statistically significant, a trend can be seen between non-Hispanic whites and repeat ERCP. Rates of interfacility transfer, home health discharge, discharge against medical advice, and in-hospital mortality also appeared to be higher in this group. ERCP: endoscopic retrograde cholangiopancreatography.

Postprocedural complications

65 (4.4%)

126 (7.1%)

0.61

(0.425, 0.881)

0.008

Median length of stay (days)

0.23

Repeat ERCP rate

412 (27.8%)

556 (31%)

0.096

Routine home discharge

1,428 (96.3%)

1,702 (95.0%)

Facility transfer, home health, AMA, in-hospital mortality

55 (3.7%)

90 (5.0%)

Diagnosis

Traumatic injury or organ laceration

13 (0.9%)

48 (2.7%)

0.34

(0.168, 0.7)

0.002

Sepsis

17 (1.2%)

25 (1.4%)

0.85

(0.403, 1.8)

0.66

Acute pancreatitis

150 (10.1%)

209 (11.7%)

0.86

(0.644, 1.1)

0.28

Chronic pancreatitis

20 (1.4%)

22 (1.2%)

1.11

(0.596, 2.1)

0.74

Obstruction of bile duct

23 (1.6%)

33 (1.9%)

0.84

(0.438, 1.6)

0.59

Cholangitis

27 (1.8%)

72 (4%)

0.44

(0.242, 0.8)

0.008

Calculus of gallbladder/bile duct

317 (21.4%)

394 (22%)

0.96

(0.781, 1.2)

0.74

Chronic cholecystitis

122 (8.3%)

136 (7.6%)

1.09

(0.818, 1.5)

0.55

Acute cholecystitis

503 (33.9%)

443 (24.8%)

1.56

(1.289, 1.9)

< 0.001

Primary sclerosing cholangitis

≤ 10

40 (2.2%)

0.27

(0.11, 0.7)

0.005

Malignancy/tumor

15 (1%)

29 (1.6%)

0.62

(0.28, 1.4)

0.24

Retained stones after cholecystectomy

28 (1.9%)

45 (2.5%)

0.75

(0.424, 1.3)

0.34

Procedural complication

22 (1.5%)

62 (3.5%)

0.41

(0.232, 0.7)

0.003

ERCP number

1,071 (72.2%)

1,236 (69%)

0.054

367 (24.7%)

484 (27%)

36 (2.5%)

56 (3.1%)

≤ 10

11 (0.6%)

≤ 10

**Table 5.** Region Comparison
Characteristics	Region (frequency (%))	P value
Regional differences are depicted. Northeast and Midwest regions were similar in that they exhibited higher rates of post-procedure complication and repeat ERCP. There was little difference in presenting diagnosis between these two regions. The South and West, which had proportionally higher numbers of Hispanic patients, exhibited lower rates of cholangitis and procedure complication as a presenting diagnosis. ERCP: endoscopic retrograde cholangiopancreatography.
Postprocedural complications	49 (7.7%)	48 (6.2%)	89 (4.9%)	55 (4.5%)	0.4	0.05	0.03
Median length of stay (days)	4	3	4	4	0.05	0.89	0.21
Repeat ERCP rate	227 (35.0%)	269 (34.5%)	520 (28.4%)	329 (26.8%)	0.81	0.01	0.002
Routine home discharge	599 (92.3%)	734 (94.9%)	1,748 (95.7%)	1,189 (96.9%)		0.001
Facility transfer, home health, AMA, in-hospital mortality	50 (7.7%)	45 (5.1%)	78 (4.3%)	39 (3.1%)
Diagnosis
Traumatic injury or organ laceration	10 (1.6%)	22 (2.9%)	42 (2.4%)	13 (1.1%)	0.19	0.34	0.42
Sepsis	≤ 10	≤ 10	28 (1.6%)	14 (1.2%)	0.66	0.43	0.81
Acute pancreatitis	59 (9.2%)	95 (12.3%)	183 (10%)	148 (12.1%)	0.13	0.63	0.13
Chronic pancreatitis	≤ 10	≤ 10	20 (1.1%)	29 (2.4%)	0.16	0.96	0.35
Obstruction of bile duct	19 (2.9%)	12 (1.7%)	41 (2.3%)	26 (2.2%)	0.2	0.57	0.45
Cholangitis	38 (5.9%)	45 (5.8%)	49 (2.7%)	33 (2.8%)	0.96	0.02	0.08
Calculus of gallbladder/bile duct	168 (25.9%)	165 (21.3%)	414 (22.7%)	266 (21.7%)	0.09	0.2	0.14
Chronic cholecystitis	40 (6.2%)	49 (6.4%)	147 (8.1%)	108 (8.8%)	0.91	0.16	0.09
Acute cholecystitis	153 (23.6%)	204 (26.2%)	537 (29.4%)	328 (26.8%)	0.46	0.06	0.36
Primary Sclerosing cholangitis	19 (3%)	24 (3.1%)	27 (1.5%)	20 (1.6%)	0.91	0.18	0.4
Malignancy/tumor	≤ 10	≤ 10	16 (0.9%)	23 (1.9%)	0.77	0.6	0.47
Retained stones after cholecystectomy	12 (1.9%)	24 (3.2%)	41 (2.3%)	23 (1.9%)	0.23	0.66	0.98
Procedural complication	26 (4.1%)	21 (2.7%)	35 (1.9%)	25 (2.1%)	0.22	0.02	0.04
ERCP number
1	420 (64.8%)	510 (65.5%)	1,306 (71.5%)	899 (73.2%)		0.001
2	203 (31.4%)	228 (29.4%)	448 (24.6%)	291 (23.7%)
3	19 (3%)	33 (4.3%)	57 (3.1%)	29 (2.4%)
4	≤ 10	≤ 10	≤ 10	≤ 10
5	≤ 10	≤ 10	≤ 10	≤ 10

Table 5. Region Comparison

Characteristics

Region (frequency (%))

P value

Northeast (n = 649)

Midwest (n = 779)

South (n = 1,826

West (n = 1,228)

Regional differences are depicted. Northeast and Midwest regions were similar in that they exhibited higher rates of post-procedure complication and repeat ERCP. There was little difference in presenting diagnosis between these two regions. The South and West, which had proportionally higher numbers of Hispanic patients, exhibited lower rates of cholangitis and procedure complication as a presenting diagnosis. ERCP: endoscopic retrograde cholangiopancreatography.

Postprocedural complications

49 (7.7%)

48 (6.2%)

89 (4.9%)

55 (4.5%)

0.4

0.05

0.03

Median length of stay (days)

0.05

0.89

0.21

Repeat ERCP rate

227 (35.0%)

269 (34.5%)

520 (28.4%)

329 (26.8%)

0.81

0.01

0.002

Routine home discharge

599 (92.3%)

734 (94.9%)

1,748 (95.7%)

1,189 (96.9%)

0.001

Facility transfer, home health, AMA, in-hospital mortality

50 (7.7%)

45 (5.1%)

78 (4.3%)

39 (3.1%)

Diagnosis

Traumatic injury or organ laceration

10 (1.6%)

22 (2.9%)

42 (2.4%)

13 (1.1%)

0.19

0.34

0.42

Sepsis

≤ 10

28 (1.6%)

14 (1.2%)

0.66

0.43

0.81

Acute pancreatitis

59 (9.2%)

95 (12.3%)

183 (10%)

148 (12.1%)

0.13

0.63

0.13

Chronic pancreatitis

≤ 10

20 (1.1%)

29 (2.4%)

0.16

0.96

0.35

Obstruction of bile duct

19 (2.9%)

12 (1.7%)

41 (2.3%)

26 (2.2%)

0.2

0.57

0.45

Cholangitis

38 (5.9%)

45 (5.8%)

49 (2.7%)

33 (2.8%)

0.96

0.02

0.08

Calculus of gallbladder/bile duct

168 (25.9%)

165 (21.3%)

414 (22.7%)

266 (21.7%)

0.09

0.2

0.14

Chronic cholecystitis

40 (6.2%)

49 (6.4%)

147 (8.1%)

108 (8.8%)

0.91

0.16

0.09

Acute cholecystitis

153 (23.6%)

204 (26.2%)

537 (29.4%)

328 (26.8%)

0.46

0.06

0.36

Primary Sclerosing cholangitis

19 (3%)

24 (3.1%)

27 (1.5%)

20 (1.6%)

0.91

0.18

0.4

Malignancy/tumor

≤ 10

16 (0.9%)

23 (1.9%)

0.77

0.6

0.47

Retained stones after cholecystectomy

12 (1.9%)

24 (3.2%)

41 (2.3%)

23 (1.9%)

0.23

0.66

0.98

Procedural complication

26 (4.1%)

21 (2.7%)

35 (1.9%)

25 (2.1%)

0.22

0.02

0.04

ERCP number

420 (64.8%)

510 (65.5%)

1,306 (71.5%)

899 (73.2%)

0.001

203 (31.4%)

228 (29.4%)

448 (24.6%)

291 (23.7%)

19 (3%)

33 (4.3%)

57 (3.1%)

29 (2.4%)

≤ 10