Expanding the Use of Endoscopic Retrograde Cholangiopancreatography in Pediatrics: A National Database Analysis of Demographics and Complication Rates

Abstract

Background: This study aimed to aid in risk assessment of pediatric endoscopic retrograde cholangiopancreatography (ERCP) candidates by utilizing a national pediatric database with a large sample to assess how patient characteristics may affect ERCP complication rates.

Methods: The Kids' Inpatient Database (KID) is a sample of pediatric discharges in states participating in the Healthcare Cost and Utilization Project (HCUP). This database provides demographic information, hospitalization duration, and outcome information for hospitalizations during which an ERCP occurred. International Classification of Diseases (ICD) codes were used to determine the hospitalization indication. ERCP complication rate was ascertained via ICD codes. All statistical analyses were performed using SAS 9.4.

Results: Complications were seen in 5.4% of hospitalizations with mortality observed in less than 0.2%. This analysis captured a large Hispanic population, specifically in the South and West regions. Gallbladder calculus and cholecystitis were more likely to occur in females. A higher percentage of patients in the age 10 - 17 group were female (72.2% vs. 52.7%, P < 0.01) and Hispanic (33.4% vs. 22.7%, P < 0.01) compared to the age 0 - 9 group. Age 0 - 5 and male gender were associated with lower routine home discharge rates and longer lengths of stay. Complications occurred at a higher rate in ages 0 - 5, though the difference was not statistically significant.

Conclusions: ERCP is a safe procedure for pediatric patients with low complication rates and rare mortality. We found statistically significant differences in the procedure indications between pediatric age groups, races, and genders. Age ≤ 5 years and male gender were associated with more complicated healthcare courses.

Keywords: Complication; Demographic; ERCP; Pancreatitis; Pediatric.

Figure 1

ICD10 procedure codes used to identify an ERCP during a hospitalization. Presenting diagnoses are provided by the KID for each individual hospitalization. Also shown are the codes used to define complication associated with performed ERCP. *A diagnosis code for pancreatitis was captured as a complication if the diagnosis code was entered within 24 h of the documented ERCP. ERCP: endoscopic retrograde cholangiopancreatography; KID: Kids’ Inpatient Database.

Figure 2

Differences in admission primary diagnosis between genders. Females had statistically higher rates of calculus of the gallbladder/bile duct (P = 0.03) and chronic cholecystitis (P = 0.02). Males had higher rates of traumatic injury (P < 0.001), obstruction of the bile duct (P < 0.001), cholangitis (P = 0.002), and primary sclerosing cholangitis (P = 0.02).