Impact of atrial fibrillation in hospitalized patients undergoing endoscopic retrograde cholangiopancreatography: A nationwide analysis

Table 1 Characteristics of patients undergoing endoscopic retrograde cholangiopancreatography in hospital, n (%)

Variable
Total study population	433245
Female	248856 (57.44)
Mean age in years	59.9
Insurance provider
Medicare	209257 (48.30)
Medicaid	66200 (15.28)
Private	134912 (31.14)
Uninsured	22876 (5.28)
Charlson comorbidity index
0	168749 (38.95)
1	89378 (20.63)
2	56148 (12.96)
3 or more	118970 (27.46)
Median income in patient zip code
$1–$38999	121611 (28.07)
$39000–$47999	114680 (26.47)
$48000–$62999	107401 (24.79)
$63000	89553 (20.67)
Hospital region
Northwest	74864 (17.28)
Midwest	96180 (22.20)
South	164806 (38.04)
West	97395 (22.48)
Hospital location
Rural	20276 (4.68)
Urban	412969 (95.32)
Hospital size
Small	67586 (15.60)
Medium	119965 (27.69)
Large	245694 (56.71)
Teaching hospital	311243 (71.84)
Race
White	290187 (66.98)
Black	41071 (9.48)
Hispanic	67759 (15.64)
Asian or Pacific Islander	16203 (3.74)
Native American	3555 (0.82)
Other	14470 (3.34)
Weekend admission	102235 (23.60)

Table 2 Characteristics of patients undergoing endoscopic retrograde cholangiopancreatogram in hospital: Atrial fibrillation vs no-atrial fibrillation, n (%)

Variable	With AF: 49615	Without AF: 383630	P value
Female	22475 (45.30)	226380 (59.01)	< 0.01
Mean age in years	76.40	57.70	< 0.01
Insurance provider			< 0.01
Medicare	41910 (84.47)	167032 (43.54)
Medicaid	1677 (3.38)	64641 (16.85)
Private	5596 (11.28)	129475 (33.75)
Uninsured	432 (0.87)	22482 (5.86)
Charlson comorbidity index			< 0.01
0	7482 (15.08)	161239 (42.03)
1	9015 (18.17)	80370 (20.95)
2	9104 (18.35)	47071 (12.27)
3 or more	24014 (48.40)	94950 (24.75)
Median income in patient zip code			< 0.01
$1–$38999	11987 (24.16)	109603 (28.57)
$39000–$47999	13639 (27.49)	101048 (26.34)
$48000–$62999	12503 (25.2)	94910 (24.74)
$63000	11486 (23.15)	78069 (20.35)
Hospital region			< 0.01
Northwest	10141 (20.44)	64718 (16.87)
Midwest	11958 (24.10)	84206 (21.95)
South	17494 (35.26)	147314 (38.40)
West	10022 (20.20)	87392 (22.78)
Hospital location			0.05
Rural	2128 (4.29)	18145 (4.73)
Urban	47487 (95.71)	365485 (95.27)
Hospital size			< 0.05
Small	7124 (14.36)	59424 (15.49)
Medium	13922 (28.06)	106073 (27.65)
Large	28569 (57.58)	218133 (56.86)
Teaching hospital	35772 (72.10)	275446 (71.80)	0.59
Race			< 0.01
White	41309 (83.26)	249282 (64.98)
Black	2575 (5.19)	38516 (10.04)
Hispanic	2789 (5.62)	64526 (16.82)
Asian or Pacific Islander	1567 (3.16)	14654 (3.82)
Native American	264 (0.53)	3302 (0.86)
Other	1111 (2.24)	13350 (3.48)
Weekend admission	11932 (24.05)	90306 (23.54)	0.27

AF: Atrial fibrillation.

Table 3 Top 5 most common primary diagnosis in patients undergoing endoscopic retrograde cholangiopancreatogram

Serial number	Diagnosis
1	Sepsis, unspecified organism
2	Obstruction of bile duct
3	Calculus of bile duct without cholangitis or cholecystitis without obstruction
4	Calculus of bile duct without cholangitis or cholecystitis with obstruction
5	Biliary acute pancreatitis

Table 4 Outcomes in patients undergoing endoscopic retrograde cholangiopancreatogram: Atrial fibrillation vs no-atrial fibrillation

Study population with ERCP (n = 433245)
	Outcomes	Without AF	With AF (multivariate regression)	P value	With AF (after propensity matching)	P value
1	In-hospital mortality	1.13%	3.82%
	OR	Ref	3.46	< 0.01	3.29	< 0.01
	AOR	Ref	1.93	< 0.01	1.74	< 0.01
2	Mean time to ERCP (days)	2.13	2.94		2.97
	Adjusted coefficient	Ref	+0.8	< 0.01	+0.50	< 0.01
3	Mean length of stay (days)	5.6	8.12
	Adjusted coefficient	Ref	+1.71	< 0.01	+1.56	< 0.01
4	Mean total charge ($)	79963	106017		100359
	Adjusted coefficient ($)	Ref	21209	< 0.01	17972	< 0.01
5	Mean total cost ($)	19214	25534
	Adjusted coefficient ($)	Ref	4869	< 0.01	Not applicable
6	Shock	3.26%	10.27%
	OR	Ref	3.39	< 0.01	3.24	< 0.01
	AOR	Ref	2.17	< 0.01	2.04	< 0.01
7	Sepsis	3.32%	6.30%
	OR	Ref	1.95	< 0.01	1.96	< 0.01
	AOR	Ref	1.34	< 0.01	1.30	< 0.01
8	Intensive care unit admission	2.30%	7.27%
	OR	Ref	3.31	< 0.01	3.08	< 0.01
	AOR	Ref	2.41	< 0.01	2.31	< 0.01
9	Acute kidney injury	12.7%	29.47%
	OR	Ref	2.87	< 0.01	2.76	< 0.01
	AOR	Ref	1.51	< 0.01	1.42	< 0.01
10	Blood transfusion	0.29%	0.49%
	OR	Ref	1.69	< 0.01	1.67	< 0.05
	AOR	Ref	1.37	0.08	1.15	0.57
11	Home discharge	78.2%	48.34%
	OR	Ref	0.26	< 0.01	0.27	< 0.01
	AOR	Ref	0.59	< 0.01	0.62	< 0.01

AF: Atrial fibrillation; AOR: Adjusted odds ratio; ERCP: Endoscopic retrograde cholangiopancreatogram; N: Total number of patients; OR: Odds ratio; Ref: Reference.

Table 5 Outcomes in patients with atrial fibrillation undergoing endoscopic retrograde cholangiopancreatogram 0-24 hours vs 24-48 hours vs 48-72 hours vs > 72 hours, n (%)

Patients getting ERCP with AF (n = 49615)
	Outcomes	ERCP 0-24 hours	ERCP 24-48 hours	P value	ERCP 48-72 hours	P value	ERCP > 72 hours	P value
		19900 (40.10)	9005 (18.14)		6180 (12.45)		14530 (29.28)
1	In-hospital mortality	3.46%	2.55%		3.07%		5.4%
	OR	Ref	0.72	0.06	0.88	0.50	1.58	< 0.01
	AOR	Ref	0.71	0.05	0.86	0.43	1.47	< 0.01
2	Mean length of stay
	Adjusted coefficient(days)	Ref	0.65	< 0.01	1.74	< 0.01	6.5	< 0.01
3	Mean total charge ($)
	Adjusted coefficient ($)	Ref	1918	0.45	11861	< 0.01	69150	< 0.01
4	Mean total cost
	Adjusted coefficient ($)	Ref	197	0.68	2628	< 0.01	16933	< 0.01
5	Shock	10.42%	7.27%		6.71%		13.45%
	OR	Ref	0.67	< 0.01	0.61	< 0.01	1.33	< 0.01
	AOR	Ref	0.65	< 0.01	0.60	< 0.01	1.30	< 0.01
6	Sepsis	6.80%	5.49%		5.17%		6.60%
	OR	Ref	0.76	0.6	0.74	< 0.05	0.96	0.74
	AOR	Ref	0.8	0.07	0.72	< 0.05	0.99	0.90
7	Intensive care unit admission	7.01%	4.27%		5.01%		10.46%
	OR	Ref	0.59	< 0.01	0.70	< 0.01	1.54	< 0.01
	AOR	Ref	0.57	< 0.01	0.70	< 0.01	1.46	< 0.01
8	Acute kidney injury	25.12%	25.76%		28.72%		38.05%
	OR	Ref	1.03	0.6	1.20	< 0.05	1.8	< 0.01
	AOR	Ref	0.98	0.8	1.13	0.11	1.72	< 0.01
9	Blood transfusion	0.5%	0.16%		0.24%		0.72%
	OR	Ref	0.30	0.05	0.43	0.18	1.30	0.39
	AOR	Ref	0.20	< 0.01	0.44	0.19	1.04	0.89
10	Home discharge	56.39%	55.10%		50.54%		39.26%
	OR	Ref	0.94	0.36	0.79	< 0.01	0.49	< 0.01
	AOR	Ref	0.99	0.97	0.85	< 0.05	0.48	< 0.01

AF: Atrial fibrillation; AOR: Adjusted odds ratio; ERCP: Endoscopic retrograde cholangiopancreatogram; N: Total number of patients; OR: Odds ratio; Ref: Reference.