title: Endoscopic retrograde cholangiopancreatography in octogenarians: A population-based study using the nationwide inpatient sample.
abstract: OBJECTIVE
  In the elderly population, there is a growing demand for minimally invasive procedures as the incidence of pancreaticobiliary disease increases with age. Patients with advanced age offer unique challenges for any procedure because they also tend to have a higher rate of baseline comorbidities and malignancy. The aim of the current study was to characterize the mortality and length of stay of octogenarians undergoing inpatient endoscopic retrograde cholangiopancreatography (ERCP).
  
  
  METHODS
  Using the 2007 - 2010 Nationwide Inpatient Sample (NIS), we performed a retrospective analysis of health-related outcomes among 80- to 89-year-old patients undergoing inpatient ERCP. Surgical patients were excluded.
  
  
  RESULTS
  An estimated 61,322 octogenarians underwent inpatient ERCP in the United States from 2007 to 2010. The mean age was 84.2 (SE 0.02) with 59.5 % (n = 36,460) of the patients being female. A large majority of the patients were white (79. %, n = 41,144) and 63.5 % (n = 38,940) had a comorbidity index of at least 2. The mean length of stay was 7.1 days (SE 0.08) with an in-hospital mortality of 3.1 % (n = 1,919). The primary discharge diagnosis was most often biliary stone disease (55.9 %, n = 34,263). A diagnosis of any infection was recorded in 45.0 % (n = 27,609) of patients. Infection was associated with a significantly higher risk of in-hospital mortality (OR 3.3, 95 % CI 2.6 - 4.2, P < 0.001).
  
  
  CONCLUSIONS
  ERCP is now routinely being performed during inpatient admissions for octogenarians with diseases of the biliary tract. The mortality of octogenarians undergoing inpatient ERCP is higher than previous reports and is likely due to superimposed infection during the same admission.
authors.affiliation: Division of Surgical Oncology, Department of General Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, United States.
authors.forename: Clancy J
authors.initials: CJ
authors.lastname: Clark
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, United States.
authors.forename: Adam
authors.initials: A
authors.lastname: Coe
authors.affiliation: Division of Public Health Sciences, Wake Forest Baptist Health, Winston-Salem, North Carolina, United States.
authors.forename: Nora F
authors.initials: NF
authors.lastname: Fino
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, United States.
authors.forename: Rishi
authors.initials: R
authors.lastname: Pawa