Outcomes Associated With Timing of ERCP in Acute Cholangitis Secondary to Choledocholithiasis

Goals: To determine the outcomes associated with timing of endoscopic retrograde cholangiopancreatography (ERCP) in patients with acute cholangitis due to choledocholithiasis, from a population-based study. Background: Although ERCP is the cornerstone in the management of patients with acute cholangitis due to choledocholithiasis, the effect of timing of ERCP on health care outcomes is not well known. Materials and Methods: In this retrospective study, national inpatient sample (NIS) data were used to identify patients with a combined primary or secondary diagnosis of cholangitis and choledocholithiasis from 1998 to 2012. Patients were divided into 4 groups based on timing of ERCP after admission: (1) ERCP performed within 24 hours (urgent ERCP); (2) ERCP performed between 24 and 48 hours (early ERCP); (3) ERCP performed after 48 hours (delayed ERCP); and (4) no ERCP performed. Main outcomes measured were length of stay (LOS), hospitalization charges, and in-hospital mortality. Results: A total of 107,253 patients were identified of which 77,323 patients underwent ERCP at any point in time. Urgent ERCP group had shortest LOS, while delayed ERCP group had significantly longer LOS than all other groups (P < 0.001). Delayed ERCP group had also the highest costs (P < 0.001). In-hospital mortality was highest in no ERCP group, followed by delayed ERCP group (P < 0.001); there was no difference in mortality between urgent ERCP and early ERCP. Conclusions: This study provides robust, population-based evidence that ERCP should not be delayed for > 48 hours in patients with acute cholangitis due to choledocholithiasis.