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Development and validation of a prediction model for admission following Endoscopic Retrograde Cholangiopancreatography.
Clin Gastroenterol Hepatol. 2015 Jun 26;
Authors: Coté GA, Lynch S, Easler JJ, Keen A, Vassell PA, Sherman S, Hui S, Xu H
Abstract
BACKGROUND: & Aims: In outpatients undergoing endoscopic retrograde cholangiopancreatography (ERCP) with anesthesia, rates of and risk factors for admission are unclear. We aimed to develop a model that would allow physicians to predict outcomes of patients during post-anesthesia recovery.
METHODS: We conducted a retrospective study of data from ERCPs performed on outpatients from May 2012 through October 2013 at the Indiana University School of Medicine. Medical records were abstracted for pre-, intra-, and early (within the first hr) post-anesthesia characteristics potentially associated with admission. Significant factors associated with admission were incorporated into a logistic regression model to identify subgroups with low, moderate, or high probabilities for admission. The population was divided into training (first 12 months) and validation (last 6 months) sets to develop and test the model.
RESULTS: We identified 3424 ERCPs during the study period; 10.7% of patients were admitted to the hospital and 3.7% developed post-ERCP pancreatitis. Post-anesthesia recovery times were significantly longer for patients requiring admission (362.6±213.0 min vs 218.4±71.8 min for patients not admitted; P<.0001). A higher proportion of admitted patients had high-risk indications. Admitted patients also had more severe comorbidities, higher baseline levels of pain, longer procedure times, performance of sphincter of Oddi manometry, higher pain during the first hour after anesthesia, and greater use of opiates or anxiolytics. A multivariate regression model identified patients that were admitted with a high level of accuracy in the training set (area under the curve [AUC]=0.83) and fair accuracy in the validation set (AUC=0.78). Based on this model, nearly 50% of patients could be classified as low risk for admission.
CONCLUSION: We developed a model, using factors that can be assessed through the first hour after ERCP, which accurately predicts which patients are likely to be admitted to the hospital. Rates of admission following outpatient ERCP are low, so the policy of prolonged observation might be unnecessary.
PMID: 26122761 [PubMed - as supplied by publisher]