Biliary drainage method and temporal trends in patients admitted with cholangitis: a national audit.

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Biliary drainage method and temporal trends in patients admitted with cholangitis: a national audit.

Can J Gastroenterol. 2013 Sep;27(9):513-8

Authors: McNabb-Baltar J, Trinh QD, Barkun AN

BACKGROUND: In patients presenting with ascending cholangitis, better outcomes are reported in those undergoing endoscopic retrograde cholangiopancreatography (ERCP) compared with surgical drainage.
OBJECTIVE: To identify factors associated with the type of intervention, and to examine temporal trends in the treatment of ascending cholangitis.
METHODS: Data were extracted from the Nationwide Inpatient Sample. Patients ≥18 years of age with a diagnosis of cholangitis between 1998 and 2009 were selected. Temporal trends were assessed using Poisson regression models. Multivariable models were fitted to predict the likelihood of a patient undergoing ERCP, percutaneous or surgical drainage, or no drainage.
RESULTS: A weighted estimate of 248,942 patients admitted for cholangitis was identified. Overall, 131,052 patients were treated with ERCP (52.6%), 10,486 with percutaneous drainage (4.2%) and 12,460 with surgical drainage (5.0%); 43.0% did not receive drainage during the admission. Temporal trends between 1998 and 2009 showed a decline in surgical and percutaneous drainage, and a rise in ERCP. In multivariable analyses adjusted for clustering, ERCP and percutaneous drainage were more often performed in institutions with a high volume of admissions for cholangitis, those with a greater bed number and hospitals located in urban areas.
CONCLUSION: Over the past decade, the use of surgical and percutaneous drainage has decreased while that of ERCP has risen. Patients treated at institutions with a low volume of admissions for cholangitis, small bed number and in rural areas were less likely to undergo ERCP or percutaneous drainage.

PMID: 24078935 [PubMed - indexed for MEDLINE]

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