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• W2921582374 abstract "Introduction: Patients with malignant biliary obstruction and prior biliary intervention are prone to develop acute cholangitis, a complication that can delay chemotherapy, prolong hospitalization, and decrease overall survival. We sought to evaluate clinical outcomes of malignant biliary obstruction and consequent acute cholangitis based on timing of biliary decompression. Methods: The 2010-2014 Nationwide Readmission Database was queried to identify adult (≥18 years) patients with a principal diagnosis of acute cholangitis and malignant biliary obstruction. Clinical outcomes were reported according to whether biliary decompression was performed early (≤ 24hr) or late (≥ 1-7 days). Primary outcomes were mortality at index admission and calendar year mortality. Inclusion criteria were patients with primary pancreaticobiliary or gastrointestinal cancer, all metastatic cancers, or lymphomas and malignancies of the bone marrow with biliary obstruction. Exclusion criteria were absence of biliary decompression or decompression after ≥ 7 days, and presence of gallstones, choledocholithiasis, or acute pancreatitis. A multivariate analysis was performed to identify reasons for late ERCP while a one-to-one propensity score-matched analysis was utilized for mortality at index admission and calendar-year mortality. Results: 923 patients were identified among which 538 (31.5%) underwent early and 385 (22.5%) late biliary decompression. The majority of biliary decompression was via ERCP, with significantly more among early decompression (91.1%, Table 1). Multivariate analysis revealed that weekend admission (Odds Ratio (OR) 2.32, 95% Confidence Interval (CI) 1.33, 4.03) and duodenal cancers (OR 8.69, 95% CI 1.59, 47.4) were associated with late biliary decompression. A propensity matched analysis (179 unweighted pairs; Table 2) revealed that late ERCP/non-endoscopic biliary decompression was associated with higher rates of index admission (OR 4.11, 95% CI 1.29, 13.12) and calendar year mortality (Hazard ratio 2.65, 95% CI 1.29, 5.45). Conclusion: Late biliary decompression >24 hours in acute cholangitis due to malignant biliary obstruction is associated with a more than two-fold increase in both index admission and calendar year mortality. Weekend admission, a potentially reversible variable, was associated with delaying biliary decompression. With the continued increase in cancer prevalence, there is a need to optimize strategies to prevent delays in managing these emergent conditions.75_A Figure 1. Demographic and Baseline Characteristics of Patients with Malignant Biliary Obstruction and Acute Cholangitis75_B Figure 2. Propensity Score-Matched Outcomes of Mortality in Cancer Patients with Acute Cholangitis" @default.
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• W2921582374 date "2018-10-01" @default.
• W2921582374 modified "2023-09-23" @default.
• W2921582374 title "Increased Mortality in Late Decompression of Acute Cholangitis in Malignant Biliary Obstruction" @default.
• W2921582374 doi "https://doi.org/10.14309/00000434-201810001-00075" @default.
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