S2307 Endoscopic Retrograde Cholangiopancreatography in Patients With Heart Failure and Pulmonary Hypertension: A Nationwide, Volume Outcome Analysis

Introduction: Heart failure (HF) and pulmonary hypertension (PH) are high-risk cardiopulmonary conditions historically associated with worse outcomes. However, there is a paucity of data for patients with HF or PH undergoing Endoscopic Retrograde Cholangiopancreatography (ERCP). We performed a retrospective analysis of outcomes among inpatients with high-risk cardiopulmonary disease undergoing ERCP using a national database and explored the interaction with hospital volume for patients with HF and PH. Methods: Patients with HF and/or PH who underwent ERCP between 2016 and 2021 were extracted from the National Inpatient Sample. Hospitals were stratified by quartiles (quartile 1 = lowest volume, quartile 4 = highest volume) based on the annual number of ERCPs done in patients with PH and HF. Multivariable regression analyses were used to compare outcomes by hospital volume (quartiles) after controlling for potential confounders. The primary outcome was all-cause inhospital mortality. Secondary outcomes included cardiac arrest and prolonged length of stay (LOS). Outcomes were reported as adjusted odds ratios (OR) and 95% confidence intervals (CI). A P-value of < 0.05 was considered statistically significant. Results: The cohort consisted of 81,725 patients with HF and PH who underwent ERCP during the study period. There was a higher proportion of women (55 vs 45%, P < 0.001). Among patients with PH and HF, the adjusted odds of death were highest in those treated at the lowest volume hospitals (quartile 1, OR 4.80 [3.33–6.98], P < 0.003). The same trend was observed for cardiac arrest (quartile 1, OR 8.51 [5.94–12.26], P < 0.0001) and LOS (quartile 1, OR 3.32 [2.88–3.94], P < 0.0001). In the higher volume hospitals, no difference in mortality (quartile 3, OR 2.94 (0.95–8.82, P = 0.14), (quartile 4, OR 1.82 (0.52–6.23, P = 0.31), cardiac arrest (quartile 3, OR 4.88 (0.95–25.68, P = 0.12) (quartile 4, OR 2.19 (0.4–11.26, P = 0.32) or prolonged LOS (quartile 3, OR 2.24 (0.95–5.16, P = 0.11) (quartile 4 OR 1.42 (0.55–3.91, P = 0.29) were observed. Patients with either HF or PH had also had worse outcomes when treated at the lowest volume hospitals. Conclusion: Patients with HF and PH undergoing inpatient ERCP at low-volume hospitals have worse outcomes compared to similar-risk patients treated at high-volume hospitals. The difference may be related to competency that develops from a higher volume of ERCPs and availability of specialty expertise such as cardiac anesthesia for these high-risk patients.