title: Delay in performing ERCP and adverse events increase the 30-day readmission risk in patients with acute cholangitis.
abstract: BACKGROUND
  Readmission to the hospital within 30 days of discharge (30-day readmission rate) is used as a quality measure.
  
  
  OBJECTIVE
  To investigate the incidence and factors that contribute to readmissions in patients with acute cholangitis.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Tertiary-care referral center.
  
  
  METHODS
  Retrospective analysis of consecutive patients admitted to our center for acute cholangitis and ERCP.
  Incidence and variables associated with 30-day readmission and 1-year mortality.
  
  
  RESULTS
  ERCP was successful in 98.8% of patients during the index admission. The 30-day readmission rate was 22.0%. Recurrence of cholangitis was the most common etiology for readmissions (37.8%). Readmission within 30 days was independently associated with failed ERCP or ERCP delayed for >48 hours (odds ratio [OR] 2.47; 95% confidence interval [CI], 1.01-6.07), development of any after-ERCP adverse event (OR 11.0; 95% CI, 3.06-39.30), and the etiology of cholangitis (etiologies not related to stones) (OR 3.3; 95% CI, 1.17-9.18). Every 1-point increase in the Charlson Comorbidity Index score (OR, 1.33; 95% CI, 1.05-1.69) was associated significantly with 1-year mortality. In unadjusted analysis, 30-day readmission after ERCP was associated significantly with 1-year mortality (OR, 2.86; 95% CI, 1.16-7.07). This association, however, was not present after adjustment for other covariates.
  
  
  CONCLUSIONS
  Retrospective study.
  
  
  CONCLUSIONS
  Delays in performing ERCP during the index admission, development of after-ERCP adverse events, and etiology of cholangitis not related to stones increased the risk of 30-day readmissions.
authors.affiliation: Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
authors.forename: Udayakumar
authors.initials: U
authors.lastname: Navaneethan
authors.forename: Norma G
authors.initials: NG
authors.lastname: Gutierrez
authors.forename: Ramprasad
authors.initials: R
authors.lastname: Jegadeesan
authors.forename: Preethi G K
authors.initials: PG
authors.lastname: Venkatesh
authors.forename: Mujtaba
authors.initials: M
authors.lastname: Butt
authors.forename: Madhusudhan R
authors.initials: MR
authors.lastname: Sanaka
authors.forename: John J
authors.initials: JJ
authors.lastname: Vargo
authors.forename: Mansour A
authors.initials: MA
authors.lastname: Parsi
mesh_terms: D000208:Acute Disease; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects* / Q000379:methods; D002761:Cholangitis / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D015331:Cohort Studies; D016001:Confidence Intervals; D016208:Databases, Factual; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D009820:Ohio; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome