Higher volume providers are associated with improved outcomes following ERCP for the palliation of malignant biliary obstruction.

Harvey, Philip R, Baldwin, Simon, Mytton, Jemma, Dosanjh, Amandip, Evison, Felicity, Patel, Prashant and Trudgill, Nigel J (2020) Higher volume providers are associated with improved outcomes following ERCP for the palliation of malignant biliary obstruction. EClinicalMedicine, 18. p. 100212. ISSN 2589-5370. This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.comz795c8c by using their UHB Athens login IDS

Full text not available from this repository.
Official URL: https://www.thelancet.com/journals/eclinm/article/...

Abstract

Background

Relieving malignant biliary obstruction improves quality of life and permits chemotherapy. Outcomes of endoscopic retrograde cholangio-pancratography(ERCP) in inoperable malignant biliary obstruction have been examined in a national cohort to establish factors associated with poor outcomes.

Methods

Hospital Episode Statistics include diagnostic and procedural data for all NHS hospital attendances in England. Patients from 2006 to 2017 with a Hepaticopancreaticobiliary (HPB) malignancy who had undergone ERCP were studied. Patients undergoing a potentially curative operation were excluded. Associations between demographics, co-morbidities, unit ERCP volume and mortality were examined by logistic regression.

Findings

39,702 patients were included; 49.4% were male; median age was 75 (IQR 66-88)years. Pancreatic cancer was the most common tumour (63.9%). Mortality was 4.1%, 9.7% and 19.1% for 7-day, in hospital and 30-day respectively. On multivariable analysis: men (OR 1.20(95%CI 1.14-1.26), < 0.001); increasing age quintile 78-83(1.73(1.59-1.89), < 0.001), >83(2.70(2.48-2.94), < 0.001); most deprived quintile (1.21(1.11-1.32), < 0.001); increasing co-morbidity score >20(3.36(2.94-3.84), < 0.001); small bowel malignancy (1.45(1.22-1.72), < 0.001), intrahepatic biliary malignancy(1.10(1.03-1.17),  = 0.005) and year of ERCP 2006/07 (1.37(1.22-1.55), < 0.001) were associated with increased 30-day mortality. Extrahepatic biliary tree cancers (0.67(0.61-0.73), <0.001), high volume providers of ERCP (>318 annually, 0.91(0.84-0.98),  = 0.01) and high volume of ERCP for malignant obstruction (>40 annually (0.91(0.85-0.98),  = 0.014) were negatively associated with 30-day mortality. Patients were less likely to require a second ERCP in high volume providers (>318, 8.0%) compared to low volume ((<204, 13.4%), <0.001).

Interpretation

Short term mortality in patients with malignant biliary obstruction following ERCP was high. 30-day mortality was positively associated with increasing age and co-morbidity, men, deprivation, and earlier year of ERCP and negatively with extrahepatic biliary tree cancer and high volume ERCP providers.

Funding

Internal funding only.

Item Type: Article
Additional Information: This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.comz795c8c by using their UHB Athens login IDS
Subjects: QZ Pathology. Oncology
WI Digestive system. Gastroenterology
Divisions: Planned IP Care > Oncology and Clinical Haematology
Related URLs:
Depositing User: Jamie Edgar
Date Deposited: 17 Jan 2020 15:38
Last Modified: 17 Jan 2020 15:38
URI: http://www.repository.uhblibrary.co.uk/id/eprint/2768

Actions (login required)

View Item View Item