Morbid obesity but not obesity is associated with increased mortality in patients undergoing endoscopic retrograde cholangiopancreatography: A national cohort study

• Published in: United European gastroenterology journal Vol. 9; no. 5; pp. 561 - 570
• Main Authors: Chen, Bing, Yo, Chia‐Hung, Patel, Ramya, Liu, Bolun, Su, Ke‐Ying, Hsu, Wan‐Ting, Lee, Chien‐Chang
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01.06.2021; John Wiley and Sons Inc
• Subjects: Alcoholism; Body Mass Index; Causality; Cause of Death; Cholangiopancreatography, Endoscopic Retrograde - adverse effects; Cholangiopancreatography, Endoscopic Retrograde - economics; Cholangiopancreatography, Endoscopic Retrograde - mortality; Cholangiopancreatography, Endoscopic Retrograde - statistics & numerical data; Chronic illnesses; Codes; Comorbidity; Confidence Intervals; Databases, Factual - statistics & numerical data; Diabetes; Endoscopy; ERCP; ERCP‐related complications; Female; Gallbladder diseases; Heart failure; Hospital Mortality; Hospitals; Humans; Kidney diseases; Length of Stay - economics; Male; Middle Aged; morbid obesity; Mortality; Multivariate Analysis; Obesity; Obesity - mortality; Obesity, Morbid - mortality; Original; Overweight; Pancreatitis; Patient Readmission; Propensity Score; Regression analysis; Retrospective Studies; United States; United States; United States > US; morbid obesity; mortality; ERCP; ERCP-related complications; obesity
• ISSN: 2050-6406; 2050-6414; 2050-6414
• DOI: 10.1002/ueg2.12070

Background The relationship between body weight and outcomes of endoscopic retrograde cholangiopancreatography (ERCP) is unclear. Objectives This study aimed to investigate the impact of obesity and morbid obesity on mortality and ERCP‐related complications in patients who underwent ERCP. Methods We conducted a US population‐based retrospective cohort study using the Nationwide Readmissions Databases (2013–2014). A total of 159,264 eligible patients who underwent ERCP were identified, of which 137,158 (86.12%) were normal weight, 12,522 (7.86%) were obese, and 9584 (6.02%) were morbidly obese. The primary outcome was in‐hospital mortality. The secondary outcomes were the length of stay, total cost, and ERCP‐related complications. Multivariate analysis and propensity score (PS) matching analysis were performed. The analysis was repeated in a restricted cohort to eliminate confounders. Results Patients with morbid obesity, as compared to normal‐weight patients, were associated with a significantly higher in‐hospital mortality (hazard ratio [HR]: 5.54; 95% confidence interval [CI]: 1.23–25.04). Obese patients were not associated with significantly different mortality comparing to normal weight (HR: 1.00; 95% CI: 0.14–7.12). Patients with morbid obesity were also found to have an increased length of hospital stay and total cost. The rate of ERCP‐related complications was comparable among the three groups except for a higher cholecystitis rate after ERCP in obese patients. Conclusions Morbid obesity but not obesity was associated with increased mortality, length of stay, and total cost in patients undergoing ERCP. Key summary Established knowledge on this subject 1. Obesity is a prevalent phenomenon. 2. The impact of obesity and morbid obesity on mortality in patients undergoing ERCP remains unclear. Significant and/or new findings of this study? 1. Morbid obesity but not obesity was associated with increased mortality in patients undergoing ERCP.