title: Follow-up to determine unplanned hospitalization and complications after endoscopic retrograde cholangiopancreatography.
abstract: BACKGROUND
  Studies of endoscopic retrograde cholangiopancreatography (ERCP)-related complications are inconsistent and sometimes have insufficient patient follow-up. The aim of this study was to investigate risk factors for ERCP-related events, leading to hospitalization in the case of outpatients and prolonged hospital stay in the case of inpatients, using assiduous follow-up and contemporaneous recording of data.
  
  
  METHODS
  Prospectively collected data of 1000 consecutive ERCP procedures performed by a single endoscopist at a tertiary referral centre in Canberra, Australia, were studied and the complications evaluated. Intense short-term follow-up with same evening and next day phone calls/consultations was undertaken with contemporaneous recording of indications, results and complications.
  
  
  RESULTS
  Of 1000 procedures, 87 patients required unplanned hospitalization or prolongation of hospital stay. Risk factors for prolonged hospital stay included unusual indication (odds ratio (OR): 3.26, confidence interval (CI): 1.36-7.79, P = 0.008), age <50 (OR: 2.05, CI: 1.30-3.23, P = 0.002), procedure time >30 min (OR: 1.85, CI: 1.17-2.94, P = 0.009), being an outpatient (OR: 1.78, CI: 1.13-2.81, P = 0.012), inability to access the bile duct (OR: 1.98, CI: 1.03-3.82, P = 0.038) and placement of a pancreatic stent (OR: 1.93, CI: 1.08-3.45, P = 0.025). Of these, all but procedure time and placement of a pancreatic stent were risk factors if multivariate analysis was used. A total of 26 patients (30% of those with unplanned hospitalization) developed self-limiting pain without apparent complications.
  
  
  CONCLUSIONS
  Both patient-related and procedure-related factors are important risk factors for determining the likelihood of unplanned post-ERCP hospitalization. There are a significant number of patients who experience self-limiting pain following ERCP, without evidence of recognized complications.
authors.affiliation: Department of Medicine, Australian National University Medical School, Canberra, Australian Capital Territory, Australia.
authors.forename: Edwina
authors.initials: E
authors.lastname: Chan
authors.affiliation: Statistical Consulting Unit, Australian National University, Canberra, Australian Capital Territory, Australia.
authors.forename: Teresa
authors.initials: T
authors.lastname: Neeman
authors.affiliation: Department of Medicine, Australian National University Medical School, Canberra, Australian Capital Territory, Australia.|Gastroenterology Unit, Canberra Hospital, Canberra, Australian Capital Territory, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Thomson
mesh_terms: D001315:Australia; D001660:Biliary Tract Diseases / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010182:Pancreatic Diseases / Q000601:surgery*; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology*; D012307:Risk Factors
keywords: complications; endoscopic retrograde cholangiopancreatography; length of stay; pancreatitis; risk factors