Variations in Incidence and Financial Burdens of Nonpancreatic Postendoscopic Retrograde Cholangiopancreatography Adverse Events

Abstract

Introduction: The risk of postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis has been extensively studied; however, nonpancreatic adverse events, such as cholangitis, bleeding, and cardiopulmonary complications, are under characterized. We aimed to characterize the 30-day incidence and financial burden of nonpancreatic post-ERCP adverse events.

Methods: We performed a cross-sectional analysis using the Merative MarketScan commercial claims database from January 1, 2019 to December 31, 2021. The study included 27,482 patients who underwent 42,318 inpatient and outpatient ERCPs. Primary outcomes were post-ERCP cholangitis, bleeding, and cardiopulmonary complications within 30 days. Financial burden was measured using total direct healthcare costs and out-of-pocket costs during the 30-day period after ERCP. Multivariable logistic regression was used to identify associated risk factors and to estimate adjusted costs.

Results: Among 27,482 patients who underwent a total of 42,318 ERCPs, nonpancreatic adverse events occurred in 5.3% of cases: cholangitis in 3.6% (95% confidence interval [CI] 3.5%-3.8%), bleeding in 1.3% (95% CI 1.2%-1.4%), and cardiopulmonary complications in 1.1% (95% CI 1.0-1.3). In multivariable analysis, adverse events were more common among men and those with higher comorbidity burden. Patients with complications had significantly higher adjusted 30-day costs: cholangitis ($38,512 vs $30,881, difference $7,631), bleeding ($43,702 vs $30,918; difference $12,748), and cardiopulmonary complications ($53,649 vs $30,918; difference $22,930). Out-of-pocket costs varied by region and insurance type but exceeded $1,000 for many patients.

Discussion: Nonpancreatic ERCP adverse events occur in over 5% of cases and can impose a substantial financial burden on both healthcare systems and patients.

Keywords: ERCP; adverse events; direct healthcare cost; out-of-pocket cost.