Background: The optimal timing for endoscopic retrograde cholangiopancreatography (ERCP) in managing uncomplicated acute biliary pancreatitis (ABP) remains unclear. This population-based study assessed the impact of ERCP timing on outcomes in hospitalized ABP patients without cholangitis or sepsis. Methods: Using the Nationwide Readmission Database (2016 to 2020), patients with ABP who underwent ERCP were identified, excluding those with cholangitis/sepsis. ERCP timing was categorized as early (0 to 1 d) or delayed (2 to 7 d). Outcomes, including mortality, 30-day readmissions, and health care resource utilization were analyzed using multivariable logistic regression. Results: Among 54, 250 noninfectious ABP patients, 42. 13% underwent ERCP. There was no significant difference in in-hospital mortality between early and delayed ERCP groups (0. 26% vs. 0. 24%, P =0. 73). However, 30-day readmission rates rose with each day of delay in the delayed ERCP group (P <0. 001) and were higher overall (8. 26% vs. 7. 51%, P =0. 03). Delayed ERCP was associated with increased 30-day readmissions (OR: 1. 11, 95% CI: 1. 00-1. 22) ; using alternate categorical thresholds, ERCP on day 4 or later was also linked to higher odds of readmission (OR: 1. 35, 95% CI: 1. 18-1. 54). Early ERCP was associated with reduced mean length of stay by 1. 51 days (95% CI: −1. 51 to −1. 50; P <0. 001) and hospital costs by 1536. 45 (95% CI: −1545. 37 to −1527. 52; P <0. 001) after multivariable adjustment. Compared with day 4 or later, ERCP on days 2 to 3 further reduced stay by 2. 42 days and costs by 3756. 95 (both P <0. 001). Conclusion: Delayed ERCP was associated with increased 30-day readmission rates and greater health care resource utilization and ERCP performed within 4 days may improve hospital quality metrics in patients with noninfectious acute biliary pancreatitis.
Chu et al. (Wed,) studied this question.