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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Impact of atrial fibrillation in hospitalized patients undergoing endoscopic retrograde cholangiopancreatography: A nationwide analysis
Ayrton I Bangolo, Rajesh Chowdary Donepudi, Vignesh K Nagesh, Joel Sandrugu, Izage Kianifar Aguilar, Rakesh Sarraf, Sawsan Suliman, Nikita Wadhwani, Cynthia Elizabeth Armendariz Espinoza, Hadrian Hoang-Vu Tran, Charlotte Levy, Budoor Alqinai, Aaron Rambaransingh, Manouchehr Adibeig, Anit Ghosal, Gulnaz Siddiqui, Nayana Bhandari, Sandeep Kotnani, Abdul Aziz Akrama, Akhila Thota, Harshan Gill, Rija Aziz, Chung H Lee, Shailaja Devi Abbisetty, Sandeep Bhangu, Karamvir Randhawa, Zubair Habib, Saba Ahmed Khan, Calvin Yee Fen Lee, Mariam Sanoh, Katherine Jacobson, Abraham Lo, Simcha Weissman
Ayrton I Bangolo, Department of Hematology and Oncology, John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ 07601, United States
Rajesh Chowdary Donepudi, Vignesh K Nagesh, Joel Sandrugu, Rakesh Sarraf, Sawsan Suliman, Nikita Wadhwani, Cynthia Elizabeth Armendariz Espinoza, Hadrian Hoang-Vu Tran, Charlotte Levy, Budoor Alqinai, Aaron Rambaransingh, Manouchehr Adibeig, Anit Ghosal, Gulnaz Siddiqui, Nayana Bhandari, Sandeep Kotnani, Abdul Aziz Akrama, Akhila Thota, Harshan Gill, Rija Aziz, Chung H Lee, Shailaja Devi Abbisetty, Sandeep Bhangu, Karamvir Randhawa, Zubair Habib, Saba Ahmed Khan, Calvin Yee Fen Lee, Mariam Sanoh, Katherine Jacobson, Abraham Lo, Simcha Weissman, Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, United States
Izage Kianifar Aguilar, Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
Co-corresponding authors: Ayrton I Bangolo and Vignesh K Nagesh.
Author contributions: Bangolo AI, Donepudi RC, Nagesh VK, Sandrugu J, Kianifar Aguilar I, Sarraf R, Suliman S, Wadhwani N, Espinoza CEA, Tran HHV, Levy C, Alqinai B, Rambaransingh A, Adibeig M, Ghosal A, Siddiqui G, Bhandari N, Kotnani S, Akrama AA, Thota A, Gill H, Aziz R, Lee CH, Abbisetty SD, Bhangu S, Randhawa K, Habib Z, Khan SA, Lee CYF, Sanoh M, and Jacobson K searched the literature, wrote and revised the manuscript; Lo A and Weissman S supervised the project; all of the authors read and approved the final version of the manuscript to be published.
Institutional review board statement: Nationwide Inpatient Sample is a publicly available database with de-identified patient information and is exempt from institutional review board approval.
Informed consent statement: Nationwide Inpatient Sample is a publicly available database with de-identified patient information and is exempt from informed consent.
Conflict-of-interest statement: The authors report no conflict of interest.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: Nationwide Inpatient Sample is a publicly available database with de-identified patient information.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Ayrton I Bangolo, MD, Department of Hematology and Oncology, John Theurer Cancer Center at Hackensack University Medical Center, 92 2
nd Street, Hackensack, NJ 07601, United States.
ayrtonbangolo@yahoo.com
Received: January 10, 2025
Revised: March 20, 2025
Accepted: April 3, 2025
Published online: December 20, 2025
Processing time: 206 Days and 23 Hours
BACKGROUND
Atrial fibrillation (AF) remains the most common cardiac arrhythmia. The safety of endoscopic retrograde cholangiopancreatography (ERCP) in patients with AF remains largely unknown.
AIM
To analyze the effect of AF on hospital outcomes in patients undergoing ERCP.
METHODS
We performed a retrospective cohort study using the Nationwide Inpatient Sample database. Adult patients with AF who underwent an inpatient ERCP were identified, then stratified by timing of ERCP, via international classification of diseases-10 codes. The primary outcome was all-cause in-hospital mortality. Secondary outcomes, including resource utilization, were assessed. Statistical analysis was performed using STATA software.
RESULTS
Of the 433245 patients that underwent an ERCP, 49615 had a diagnosis of AF. Patients with AF had a significantly higher in-hospital mortality compared to those without AF [3.82% vs 1.13%, odds ratio (OR) = 1.93, P < 0.01]. AF was significantly associated with increased hospital stay (+1.71 days), hospital charges ($21210), shock (OR = 2.17), sepsis (OR = 1.34), intensive care unit admission (OR = 2.41), acute kidney injury (OR = 1.51), as well as a decreased likelihood of discharge to home (OR = 0.59), (all with P < 0.01). These results were consistent after propensity score matching. Upon subgroup analysis, patients with AF, whom underwent ERCP > 72 hours, had worse outcomes including higher in-hospital mortality (adjusted OR = 1.47, P < 0.01).
CONCLUSION
By way of this large, national analysis it appears AF is associated with significantly worse hospitalization outcomes, inducing increased mortality, in those undergoing ERCP. Further prospective investigation is warranted to potentially guide clinical recommendations for patients with AF undergoing ERCP in this setting.
Core Tip: Atrial fibrillation (AF) significantly worsens hospital outcomes, including increased mortality, longer hospital stays, higher costs, and complications, in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). Delaying ERCP beyond 72 hours in patients with AF further exacerbates these risks. Prospective studies are needed to optimize management strategies for this high-risk population.
