Factors Associated With Delayed Endoscopic Retrograde Cholangiopancreatography Among Patients With Acute Cholangitis.

Background and goals: Delayed ERCP is associated with increased morbidity and mortality from acute cholangitis (AC). We aimed to identify the factors associated with delayed receipt of early or urgent ERCP among patients with AC.

Study: For this retrospective cohort study, we analyzed data from the 2016 to 2020 iterations of the Nationwide Inpatient Sample. We stratified the study population as severe versus nonsevere AC and timing of ERCP as urgent (within 24 h of admission), early (between 24 and 48 h of admission), and late (after 48 h of admission). Using multivariable logistic regression, we examined for the factors associated with delay in urgent or early ERCP overall and delay in urgent ERCP among patients with severe AC.

Results: Of the 12,613 participants included in this study, 3032 (24.0%) had severe AC. Blacks [aOR 1.53; 95% CI (1.27, 1.85)], Asians/Pacific Islanders [aOR 1.22; 95% CI (1.02, 1.46)], those with a history of bariatric surgery [aOR 2.10; 95% CI (1.40, 3.17)] and those with one [aOR 1.33; 95% CI (1.13, 1.58)] or more comorbidities were more likely to have a delay in receiving ERCP within 48 hours of admission when compared with non-Hispanic Whites and those with no comorbidities respectively. Racial disparities were not observed among patients with severe AC.

Conclusion: Black/AA and API's presenting with AC are more likely to have a delay in the receipt of ERCP within 48 hours of admission. Assessing the impact of medical comorbidities on procedural risk is important when deciding timing of ERCP.