title: Hospital volume status is related to technical failure and all-cause mortality following ERCP for benign disease.
abstract: BACKGROUND
  Population-based data on hospital procedure volume and outcome of endoscopic retrograde cholangiopancreatography (ERCP) are limited.
  
  
  OBJECTIVE
  To investigate procedural failure, early re-admission, and all-cause mortality following ERCP performed due to benign disease and to examine their relation to hospital procedure volume.
  
  
  METHODS
  All patients with a first ERCP in 2005-2008 in Sweden were identified from the Swedish Hospital Discharge Registry. Data on indication, admission method, length of stay (LOS), and comorbid illness were extracted. Patients were linked to the Swedish Death and Cancer Registries. Factors associated with failed index ERCP, early re-admission, and all-cause mortality were identified by multiple logistic analyses.
  
  
  RESULTS
  Overall, 12,695 first ERCPs for benign disease were analyzed. The 30-day re-admission rate was 13 % and all-cause 30-day mortality 2.2 %. Failed index ERCP was more common in low-volume than high-volume institutions (p = 0.007). In logistic regression analysis, low hospital procedure volume was an independent predictor of failed index ERCP (odds ratio (OR) 2.72 vs. high), but not 30-day re-admission (p > 0.05). LOS was longer in cases of procedural failure (p < 0.001). All-cause 30-day mortality was independently related to low hospital ERCP volume (OR 1.41 vs. high) and failed ERCP (OR 5.65 vs. successful).
  
  
  CONCLUSIONS
  In this population-based cohort of first ERCPs due to benign disease, lower hospital ERCP volume was related to failed ERCP, which, in turn, was associated with longer LOS. Failed ERCP and lower hospital procedure volume were associated with poor survival, but not with early re-admission following index ERCP. These findings may have implications for service development.
authors.affiliation: Endoscopy Unit, Department of Gastroenterology, Skåne University Hospital, University of Lund, Malmö, Sweden, evangelos.kalaitzakis@medicine.gu.se.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Kalaitzakis
authors.forename: Ervin
authors.initials: E
authors.lastname: Toth
mesh_terms: D000368:Aged; D001660:Biliary Tract Diseases / Q000401:mortality* / Q000601:surgery*; D002423:Cause of Death; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data; D012042:Registries; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D017211:Treatment Failure