S104 Learning Curves and Bile Ducts: A Propensity-Matched Study on Trainee Involvement in Acute Cholangitis

Introduction: This study analyzed acute cholangitis outcomes in teaching hospitals, comparing July-September (new trainees) to April-June (experienced trainees). Outcomes were evaluated to determine the impact of trainee experience on patient care during these critical educational periods. Methods: This study analyzed adult hospitalizations (age >18) with acute cholangitis in U.S. teaching hospitals using the National Inpatient Sample (2016 to 2020). A retrospective multivariate analysis was conducted using SAS 9.4 to evaluate inpatient mortality, length of stay (LOS), total hospital charges (THC, adjusted to 2020 USD), critical care interventions (e.g., intubation, ICU admission, CVC placement), endoscopic retrograde cholangiopancreatography (ERCP) utilization (with/without intervention), and ERCP timing from admission. Results: Total of 12,360 patients were included in this analysis, out of those 6355 (∼51.42%) were admitted during July-Sept and 6005 (∼48.58%) were admitted during April-June across 5 years (2016 to 2020) period in the U.S. Median age of the patients were 73 years (IQR: 61-83) and 72 years (IQR: 61-83) for the period of July-Sept and April-June, respectively. Primary outcomes showed no difference in terms of in-patient mortality in between 2 groups (3.49% vs 2.95%, P = 0.1061). THC was slightly higher in the April-June group ($15,492 vs $14,553) than the July-Sept group. There was significantly higher rates for ICU admissions (6.26% vs 4.83%, P = 0.0009) and intubation (5.09% vs 3.75%, P = 0.0006) for the patients those were managed during the months of the July-Sept than those who were managed in the April-June. But there was no difference between 2 groups requiring CVC line placement (1.88% vs 1.79%, P = 0.7245) and ERCP utilization (85.17% vs 85.25%, P = 0.8941). Analysis revealed the majority of the patients had ERCP in between 24-48 hours of admission in both the groups (51.09% vs 50.03%), than within 24 hours (25.42% vs 25.02%), and after 48 hours (23.48% vs 24.85%). However, there was no significant difference in timing between the 2 groups. Conclusion: Acute cholangitis has no significant difference in mortality, LOS, THC, ERCP utilization, or ERCP timing between the 2 groups. However, patients managed from July to September experienced higher rates of ICU admissions and intubations compared to those managed from April to June. This may indicate a lower threshold for critical interventions due to trainee inexperience, with higher life sustaining intervention rates driven by heightened patient safety measures to prevent errors.