Time-to-ercp for ascending cholangitis during the start of the covid-19 pandemic

Riverside Health System, USA; Mayo Clinic in Florida, USA; CIDMA, Spain; Samodzielny Publiczny Zaklad Opieki Zdrowotnej Ministerstwa Spraw Wewnetrznych i Administracji w Szczecinie, Poland; Eastern Virginia Medical School, USA; HELIOS Frankenwaldklinik Kronach, Germany. I understand. Paul Kröner: NO financial relationship with a commercial interest; Do Han Kim: NO financial relationship with a commercial interest; Donghyun Ko: NO financial relationship with a commercial interest; Alvaro Martínez- Alcalá: NO financial relationship with a commercial interest; Katarzyna M. Pawlak: Speaking and Teaching: Olympus; Alejandra Vargas: NO financial relationship with a commercial interest; Ana Rosa Vilela Sangay: NO financial relationship with a commercial interest; John Boyd: NO financial relationship with a commercial interest; Timothy Lee: NO financial relationship with a commercial interest; Klaus Monkemuller: NO financial relationship with a commercial interest; Frank Lukens: NO financial relationship with a commercial interest; Pedro Palacios Argueta: NO financial relationship with a commercial interest. Introduction: With the early rapid dissemination of COVID-19 and the uncertainty generated in the early months of the pandemic, access to healthcare for elective, subacute and acute medical conditions across the US was significantly impacted. In gastrointestinal surgery, greater mortality odds were detected in patients who developed complications during the pandemic compared to pre-pandemic estimates. Downstream hospital understaffing also resulted in increased rates of staff burnout, near misses, and other adverse outcomes for various emergent conditions. The aim of this study was to explore hypothesized impact of the pandemic on the timing of ERCP in patients with ascending cholangitis (AC) before and during the early pandemic months. Methods: A retrospective observational study was conducted by querying the National Inpatient Sample for the year 2020. All patients with associated principal diagnostic ICD-10 codes for AC were included. Patients undergoing ERCP were identified using ICD-10 procedural codes. All patients with primary sclerosing cholangitis were excluded. The primary outcome was the variation in the timing of ERCP (using day of admission as a reference) on a monthly basis utilizing January 2020 (i.e. pre-pandemic) as a comparator. Secondary outcomes were inpatient mortality, morbidity and resource utilization in patients undergoing early ERCP (defined as ERCP within 24 hours of admission) compared to non-early ERCP. Multivariate regression analyses were used to adjust for gender, age, insurance status, Charlson Comorbidity Index, income in patient zip code, hospital region, location, size and teaching status. Results: A total of 151,705 patients with AC who underwent ERCP were identified. The mean age was 61.3 and 54.6% were female. The mean time-to-ERCP in 2020 was 2.34 days. For the primary outcome, there was no statistically significant adjusted variation in the mean time-to-ERCP throughout the different months of the year compared to January (pre-pandemic). Patients with early-ERCP had clear decreased adjusted odds for mortality (aOR: 0.27, p<0.01). For secondary outcomes, these patients displayed lower odds of AKI (aOR: 0.70, p<0.01), shock (aOR: 0.72, p<0.01), sepsis (aOR: 0.88, p<0.01), ICU (aOR: 0.59, p<0.01), and multi-organ failure (aOR: 0.67, p<0.01) compared to those undergoing non-early-ERCP. Resource utilization and LOS were significantly lower in patients with AC undergoing early-ERCP. All results are displayed in Table 1. Conclusion: There was no variation in the timing of ERCP in patients with ascending cholangitis who presented during the early pandemic months as compared to pre-pandemic levels. As reflected in this and numerous prior studies, the importance of early ERCP in ascending cholangitis cannot be understated. This was reflected by significantly decreased odds of mortality, morbidity and resource utilization. Table 1. Adjusted Odds Ratio and Adjusted Means for Outcomes in Patients Undergoing Early-ERCP in Patients with Acute Cholangitis during the Pandemic compared to Non-Early ERCP Table 2. Adjusted Time-To-ERCP Means (additional days) in Patients with Ascending Cholangitis Undergoing ERCP during the early Pandemic Compared to January (pre-pandemic).