Biliary drainage method and temporal trends in patients admitted with cholangitis: a national audit.
BACKGROUND
In patients presenting with ascending cholangitis, better outcomes are reported in those undergoing endoscopic retrograde cholangiopancreatography (ERCP) compared with surgical drainage.


OBJECTIVE
To identify factors associated with the type of intervention, and to examine temporal trends in the treatment of ascending cholangitis.


METHODS
Data were extracted from the Nationwide Inpatient Sample. Patients ≥18 years of age with a diagnosis of cholangitis between 1998 and 2009 were selected. Temporal trends were assessed using Poisson regression models. Multivariable models were fitted to predict the likelihood of a patient undergoing ERCP, percutaneous or surgical drainage, or no drainage.


RESULTS
A weighted estimate of 248,942 patients admitted for cholangitis was identified. Overall, 131,052 patients were treated with ERCP (52.6%), 10,486 with percutaneous drainage (4.2%) and 12,460 with surgical drainage (5.0%); 43.0% did not receive drainage during the admission. Temporal trends between 1998 and 2009 showed a decline in surgical and percutaneous drainage, and a rise in ERCP. In multivariable analyses adjusted for clustering, ERCP and percutaneous drainage were more often performed in institutions with a high volume of admissions for cholangitis, those with a greater bed number and hospitals located in urban areas.


CONCLUSIONS
Over the past decade, the use of surgical and percutaneous drainage has decreased while that of ERCP has risen. Patients treated at institutions with a low volume of admissions for cholangitis, small bed number and in rural areas were less likely to undergo ERCP or percutaneous drainage.
Julia
J
McNabb-Baltar
Quoc-Dien
QD
Trinh
Alan N
AN
Barkun
D000328:Adult; D000368:Aged; D002170:Canada / Q000453:epidemiology; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods / Q000706:statistics & numerical data; D002761:Cholangitis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D054869:Clinical Audit; D057186:Comparative Effectiveness Research; D004322:Drainage / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006761:Hospitals / Q000145:classification / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D012959:Socioeconomic Factors