All-cause mortality, adverse events and associated factors following endoscopic retrograde cholangiopancreatography for benign indications in England

Population-based data on outcomes of endoscopic retrograde cholangiopancreatography (ERCP) for benign indications are limited. We examined the impact of changing patient demographics on ERCP outcomes. Adults undergoing first ERCP for benign indications between 2003 and 2020 in England were identified in Hospital Episode Statistics. All-cause mortality within 30 days and adverse event rates within 7 days were calculated. Multivariable logistic regression analysis explored factors associated with all-cause mortality. A total of 283,972 patients were included; 63.4% female; median age 67 years (interquartile range 50–79). Twenty-five percent of ERCPs in 2019/2020 were performed in patients with a Charlson comorbidity score ≥ 5, compared with 8% in 2003/2004. Three percent of patients who underwent day case ERCP had an emergency readmission with pancreatitis. Thirty-day all-cause mortality fell by 31% over the study period. Mortality was associated with age (age quintile ≥ 82 years; odds ratio 19.22; 95% confidence interval [CI] 15.59–23.69 compared with 18–46 years), male sex (1.21; CI 1.14–1.27), Black or Black British ethnicity (1.42; CI 1.07–1.90), increasing comorbidity score ≥ 5 (3.35; CI 3.14–3.57), and increasing provider annual ERCP volume (volume ≥ 151; 1.08; CI 1.01–1.16). Elective ERCP (0.30; CI 0.28–0.33) and those in recent years were associated with lower mortality (2019/2020 compared with 2003/2004 (0.40; CI 0.34–0.48). Statistically significant variations in 30-day all-cause mortality were observed between ERCP providers. Despite the increasing age and comorbidities of patients undergoing ERCP for benign indications, 30-day all-cause mortality fell by 31% in recent years. All-cause mortality was associated with age, males, comorbidities, black ethnicity, emergency ERCP, and increasing provider volume.