Lower provider volume is associated with higher failure rates for endoscopic retrograde cholangiopancreatography

Gregory A. Coté, Timothy D. Imler, Huiping Xu, Evgenia Teal, Dustin D. French, Thomas F. Imperiale, Marc B. Rosenman, Jeffery Wilson, Siu L. Hui, Stuart Sherman

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

BACKGROUND: Among physicians who perform endoscopic retrograde cholangiopancreatography (ERCP), the relationship between procedure volume and outcome is unknown. OBJECTIVE: Quantify the ERCP volume-outcome relationship by measuring provider-specific failure rates, hospitalization rates, and other quality measures. RESEARCH DESIGN: Retrospective cohort. SUBJECTS: A total of 16,968 ERCPs performed by 130 physicians between 2001 and 2011, identified in the Indiana Network for Patient Care. MEASURES: Physicians were classified by their average annual Indiana Network for Patient Care volume and stratified into low (<25/y) and high (≥25/y). Outcomes included failed procedures, defined as repeat ERCP, percutaneous transhepatic cholangiography or surgical exploration of the bile duct≤7 days after the index procedure, hospitalization rates, and 30-day mortality. RESULTS: Among 15,514 index ERCPs, there were 1163 (7.5%) failures; the failure rate was higher among low (9.5%) compared with high volume (5.7%) providers (P<0.001). A second ERCP within 7 days (a subgroup of failure rate) occurred more frequently when the original ERCP was performed by a low-volume (4.1%) versus a high-volume physician (2.3%, P=0.013). Patients were more frequently hospitalized within 24 hours when the ERCP was performed by a low-volume (28.3%) versus high-volume physician (14.8%, P=0.002). Mortality within 30 days was similar (low=1.9%, high=1.9%). Among low-volume physicians and after adjusting, the odds of having a failed procedure decreased 3.3% (95% confidence interval, 1.6%-5.0%, P<0.001) with each additional ERCP performed per year. CONCLUSIONS: Lower provider volume is associated with higher failure rate for ERCP, and greater need for postprocedure hospitalization.

Original languageEnglish (US)
Pages (from-to)1040-1047
Number of pages8
JournalMedical care
Volume51
Issue number12
DOIs
StatePublished - Dec 1 2013

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Endoscopic Retrograde Cholangiopancreatography
Physicians
Hospitalization
Patient Care
Cholangiography
Mortality
Bile
Confidence Intervals

Keywords

  • ERCP quality
  • gastroenterology
  • outcomes

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Lower provider volume is associated with higher failure rates for endoscopic retrograde cholangiopancreatography. / Coté, Gregory A.; Imler, Timothy D.; Xu, Huiping; Teal, Evgenia; French, Dustin D.; Imperiale, Thomas F.; Rosenman, Marc B.; Wilson, Jeffery; Hui, Siu L.; Sherman, Stuart.

In: Medical care, Vol. 51, No. 12, 01.12.2013, p. 1040-1047.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND: Among physicians who perform endoscopic retrograde cholangiopancreatography (ERCP), the relationship between procedure volume and outcome is unknown. OBJECTIVE: Quantify the ERCP volume-outcome relationship by measuring provider-specific failure rates, hospitalization rates, and other quality measures. RESEARCH DESIGN: Retrospective cohort. SUBJECTS: A total of 16,968 ERCPs performed by 130 physicians between 2001 and 2011, identified in the Indiana Network for Patient Care. MEASURES: Physicians were classified by their average annual Indiana Network for Patient Care volume and stratified into low (<25/y) and high (≥25/y). Outcomes included failed procedures, defined as repeat ERCP, percutaneous transhepatic cholangiography or surgical exploration of the bile duct≤7 days after the index procedure, hospitalization rates, and 30-day mortality. RESULTS: Among 15,514 index ERCPs, there were 1163 (7.5{\%}) failures; the failure rate was higher among low (9.5{\%}) compared with high volume (5.7{\%}) providers (P<0.001). A second ERCP within 7 days (a subgroup of failure rate) occurred more frequently when the original ERCP was performed by a low-volume (4.1{\%}) versus a high-volume physician (2.3{\%}, P=0.013). Patients were more frequently hospitalized within 24 hours when the ERCP was performed by a low-volume (28.3{\%}) versus high-volume physician (14.8{\%}, P=0.002). Mortality within 30 days was similar (low=1.9{\%}, high=1.9{\%}). Among low-volume physicians and after adjusting, the odds of having a failed procedure decreased 3.3{\%} (95{\%} confidence interval, 1.6{\%}-5.0{\%}, P<0.001) with each additional ERCP performed per year. CONCLUSIONS: Lower provider volume is associated with higher failure rate for ERCP, and greater need for postprocedure hospitalization.",
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AU - Imler, Timothy D.

AU - Xu, Huiping

AU - Teal, Evgenia

AU - French, Dustin D.

AU - Imperiale, Thomas F.

AU - Rosenman, Marc B.

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N2 - BACKGROUND: Among physicians who perform endoscopic retrograde cholangiopancreatography (ERCP), the relationship between procedure volume and outcome is unknown. OBJECTIVE: Quantify the ERCP volume-outcome relationship by measuring provider-specific failure rates, hospitalization rates, and other quality measures. RESEARCH DESIGN: Retrospective cohort. SUBJECTS: A total of 16,968 ERCPs performed by 130 physicians between 2001 and 2011, identified in the Indiana Network for Patient Care. MEASURES: Physicians were classified by their average annual Indiana Network for Patient Care volume and stratified into low (<25/y) and high (≥25/y). Outcomes included failed procedures, defined as repeat ERCP, percutaneous transhepatic cholangiography or surgical exploration of the bile duct≤7 days after the index procedure, hospitalization rates, and 30-day mortality. RESULTS: Among 15,514 index ERCPs, there were 1163 (7.5%) failures; the failure rate was higher among low (9.5%) compared with high volume (5.7%) providers (P<0.001). A second ERCP within 7 days (a subgroup of failure rate) occurred more frequently when the original ERCP was performed by a low-volume (4.1%) versus a high-volume physician (2.3%, P=0.013). Patients were more frequently hospitalized within 24 hours when the ERCP was performed by a low-volume (28.3%) versus high-volume physician (14.8%, P=0.002). Mortality within 30 days was similar (low=1.9%, high=1.9%). Among low-volume physicians and after adjusting, the odds of having a failed procedure decreased 3.3% (95% confidence interval, 1.6%-5.0%, P<0.001) with each additional ERCP performed per year. CONCLUSIONS: Lower provider volume is associated with higher failure rate for ERCP, and greater need for postprocedure hospitalization.

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