Diagnostic and Therapeutic Endoscopy / 2016 / Article / Tab 3

Clinical Study

Therapeutic Endoscopy Can Be Performed Safely in an Ambulatory Surgical Center: A Multicenter, Prospective Study

Table 3

Outcomes and cost for inpatient versus ASC ERCP, EUS, and the total population.

ERCPEUSTotal
INASCALL (95% CI)INASCALL (95% CI)INASCALL (95% CI)

Outcomes
Postprocedural complications10 (13%)12 (8%)18 (8%)0.201 (5%)4 (3%)5 (4%)0.6011 (11%)16 (6%)27 (7%)0.11
Pancreatitis7 (9%)11 (7%)18 (8%)0.601 (5%)3 (3%)4 (3%)0.208 (8%)14 (5%)22 (6%)0.43
Hemorrhage3 (4%)1 (1%)4 (2%)0.2501 (1%)1 (1%)0.983 (3%)2 (0.7%)5 (1%)0.92
Perforation0001.000001.000001.00

Mortality
All-cause7 (9%)1 (1%)8 (3%)0.011 (5%)2 (2%)3 (2%)0.129 (9%)3 (1%)12 (3%)0.09

Service call
Fevers7 (9%)2 (1%)9 (4%)0.022 (9%)2 (2%)4 (3%)1.009 (9%)4 (1%)13 (4%)0.047
Nausea/vomiting8 (11%)17 (11%)25 (11%)0.8707 (6%)7 (5%)0.988 (8%)24 (9%)32 (9%)0.79
Abdominal pain16 (21%)37 (23%)53 (23%)0.412 (9%)11 (9%)13 (9%)0.9818 (18%)48 (17%)66 (18%)0.13

Medical care
ED2 (3%)5 (3%)7 (3%)0.6002 (2%)2 (%)0.942 (2%)7 (3%)9 (2%)0.70
Urgent care1 (1%)2 (1%)3 (1%)1.000001.001 (1%)2 (1%)3 (1%)0.90
Hospitalization1 (1%)4 (3%)5 (2%)0.3202 (2%)2 (1%)0.941 (1%)6 (2%)7 (2%)0.34
LOS9.30.63.6<0.00014.40.72.80.218.70.82.8<0.0001
Readmission8 (11%)10 (6%)18 (8%)0.041 (5%)10 (9%)11 (8%)0.809 (19%)20 (7%)29 (8%)0.17

Cost
Procedure489.60474.30490.700.12339.10292.20438.400.35482.30423.20438.40<0.0001
Total19,022.901,574.307,662.80<0.00019,196.301,668.906,082.200.2117,815.702,026.906,082.20<0.0001

ERCP: endoscopic retrograde cholangiopancreatography; EUS: endoscopic ultrasound; IN: inpatients; ASC: ambulatory surgical center patients; ALL: inpatients + ASC patients; ARDS: acute respiratory distress syndrome; CI: confidence interval; SIRS: systemic inflammatory response syndrome; MOF: multiple organ failure; MI: myocardial infarction; ED: emergency department; LOS: length of stay.
Note that is significant.
Inpatient that suffered cardiac arrest or respiratory failure was found to have septic shock and mild pancreatitis on day 21 after ERCP.
A second inpatient after cancer surgery died of septic shock.
ASC admitted on day 28 with pancreatitis or respiratory failure was DNR/DNI but family desired to be made hospice.
ASC admitted with septic/cardiogenic shock after surgery for cancer.
Note that no urgent care visits were hospitalized.
Note that all hospitalizations were sent from a call to the service or directly from the endoscopy unit to the ED.

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