Impact of atrial fibrillation on in-hospital outcomes following endoscopic retrograde cholangiopancreatography: a propensity score-matched analysis of the National Inpatient Sample (2016-2020)

Abdulrahim Y. Mehadi; Bekure B. Siraw; Parth Patel; Eli A. Zaher; Ebrahim A. Mohamed; Shahin Isha; Abel Tenaw Tasamma; Yordanos T. Tafesse; Yonas Gebrecherkos; Juveriya Yasmeen; Mouaz Oudih; Mohammed Haroun

Authors Abdulrahim Y. Mehadi, Bekure B. Siraw, Parth Patel, Eli A. Zaher, Ebrahim A. Mohamed, Shahin Isha, Abel Tenaw Tasamma, Yordanos T. Tafesse, Yonas Gebrecherkos, Juveriya Yasmeen, Mouaz Oudih, Mohammed Haroun.

Abstract

Background Endoscopic retrograde cholangiopancreatography (ERCP) is a critical tool in managing hepatobiliary and pancreatic diseases. Atrial fibrillation (AF) has been associated with greater morbidity in patients undergoing ERCP. This study compared in-hospital ERCP outcomes in patients with and without AF.

Methods This retrospective cohort study utilized data from the National Inpatient Sample (2016-2020). Patients who underwent ERCP during hospitalization were included. Patients with AF were matched 1:1 to those without AF, based on demographic and clinical variables. The primary outcome was all-cause in-hospital mortality. Secondary outcomes included procedurerelated and non-procedure-related complications, hospitalization cost and length of stay.

Results The final matched sample consisted of 29,942 patients, with 14,971 in each group (AF and non-AF). Patients with AF demonstrated significantly higher in-hospital mortality compared to those without AF (3.6% vs. 1.9%; odds ratio [OR] 1.87, 95% confidence interval [CI] 1.62-2.17). The AF group had a significantly longer median length of stay (8.1 vs. 6.4 days; β 1.7; 95%CI 1.5-1.8) and incurred higher hospitalization costs ($111,000 vs. $87,255; β $23,745; 95%CI $20,783-26,708). In terms of complications, patients with AF had significantly higher rates of acute kidney injury (OR 1.33, 95%CI 1.27-1.40) and sepsis (OR 1.38, 95%CI 1.30-1.48). However, the rates of procedure-specific complications, including biliary perforation, post-ERCP pancreatitis and post-ERCP cholangitis, were similar between the 2 groups.

Conclusion Patients with AF undergoing ERCP have higher in-hospital mortality, longer stays, greater costs, and higher rates of acute kidney injury and sepsis, although procedure-specific complication rates remain unaffected.

Keywords Endoscopic retrograde cholangiopancreatography, atrial fibrillation, mortality, in-hospital outcome, national inpatient sample

Ann Gastroenterol 2025; 38 (3): 345-352