内镜逆行胰胆管造影术后胰腺炎的发生情况及影响因素分析:基于美国住院患者样本数据库的回顾性研究

Endoscopic retrograde cholangiopancreatography-associated pancreatitis:incidence,and risk factors analysis based on the nationwide inpatient sample database in the US

目的探讨基于大样本量的内镜逆行胰胆管造影术后胰腺炎(PEP)的发生率及其危险因素,以实现有针对性的围手术期管理,减少手术并发症,改善患者预后。方法通过查询美国国家住院患者(NIS)数据库,使用国际疾病分类第九版和国际疾病分类第十版手术编码识别2010-2019年接受内镜逆行胰胆管造影术的成人患者。根据有无PEP的发生,将符合纳入标准的患者分为PEP组和非PEP组,并使用秩和检验和卡方检验分析患者人口统计学特征、医院特征、住院时间、相关经济指标以及住院死亡率,并通过多元logistic回归分析发生PEP的相关影响因素。结果共识别出337515例内镜逆行胰胆管造影术后患者,其中15148例发生了PEP,发生率为4.49%。PEP组中男性患者占比(44.32%)高于非PEP组中男性占比(41.59%)(P<0.05);PEP组与非PEP组中不同人种的分布差异具有统计学意义(P<0.05);PEP组患者住院死亡率为3.60%,高于非PEP组的1.33%(P<0.05)。此外,PEP的发生使患者住院时间中位数增加了3 d(P<0.05);同时PEP组患者住院总费用中位数相比非PEP组患者增加了22795美元(P<0.05)。logistic回归结果显示,使用医疗补助支付(OR=1.16)、城市医院(OR=1.40)、术前合并获得性免疫缺陷综合征(OR=1.87)、术前酗酒(OR=1.38)、术前合并缺铁性贫血(OR=1.12)、术前合并充血性心力衰竭(OR=1.26)、术前合并凝血功能障碍(OR=1.33)、术前合并液体和电解质紊乱(OR=1.58)、术前合并其他神经系统疾病(OR=1.28)、术前合并肥胖(OR=1.16)、术前合并瘫痪(OR=1.30)、术前合并肾功能衰竭(OR=1.25)等为患者发生PEP的危险因素(P<0.05)。结论接受内镜逆行胰胆管造影术患者PEP的总体发生率较高,会导致不良的后果。识别PEP的危险因素有助于对接受内镜逆行胰胆管造影术的患者制定合适的围手术期管理方案,进而改善患者预后。

Objective To investigate the incidence of post-ERCP pancreatitis(PEP)and its risk factors based on a large sample size,in order to implement targeted perioperative management,reduce surgical complications,and promote patient outcomes.Methods By querying the US National Inpatient Sample(NIS)database,adult patients who underwent ERCP from 2010 to 2019 were identified using the International Classification of Diseases,Ninth Revision(ICD-9)and Tenth Revision(ICD-10)procedural codes.Patients meeting the inclusion criteria were divided into PEP and non-PEP groups based on the occurrence of PEP.Patient demographic characteristics,hospital characteristics,length of hospital stay,related economic indicators,and in-hospital mortality rates were assessed using rank sum tests and chi-square tests.Multivariate logistic regression analysis was used to analyze factors associated with the occurrence of PEP.Results A total of 337515 patients who underwent ERCP were identified,with 15148 cases of PEP,resulting in an incidence of 4.49%.The proportion of male patients in the PEP group was significantly higher than that in the non-PEP group(44.32%vs.41.59%;P<0.05).The distribution of different ethnicities in the PEP and non-PEP groups was statistically significant(P<0.05).The in-hospital mortality rate for patients in the PEP group was significantly higher than that in the non-PEP group(3.60%vs.1.33%;P<0.05).Additionally,the occurrence of PEP increased the median length of hospital stay significantly by 3 days(P<0.05);meanwhile,the median total hospitalization cost for patients in the PEP group was$22795 higher than that for patients in the non-PEP group(P<0.05).Logistic regression results showed that the use of Medicaid payment(OR=1.16),urban hospitals(OR=1.40),preoperative acquired immunodeficiency syndrome(OR=1.87),preoperative alcohol abuse(OR=1.38),preoperative iron-deficiency anemia(OR=1.12),preoperative congestive heart failure(OR=1.26),preoperative coagulation disorders(OR=1.33),preoperative fluid and electrolyte disorders(OR=1.58),preoperative other neurological diseases(OR=1.28),preoperative obesity(OR=1.16),preoperative paralysis(OR=1.30),and preoperative renal failure(OR=1.25)were risk factors for the occurrence of PEP among them(P<0.05).Conclusion The overall incidence of PEP in patients undergoing ERCP remains high and causes adverse outcomes in the US.Identifying risk factors for PEP can help formulate appropriate perioperative management plans for patients undergoing ERCP,thereby further improving patient outcomes.