Association of Post-ERCP Complications with Hospital Admission Period
Notice bibliographique
Résumé
Introduction: Numerous studies have been performed to evaluate the hypothesis that patient outcomes are worse during the beginning of the academic year for trainees in July. However, no study has assessed for differences in Endoscopic Retrograde Cholangiopancreatography [ERCP] outcomes based on admission quarter. We studied differences in post-ERCP complication rates of gastrointestinal [GI] bleed, perforation, cholecystitis and mortality based on which quarter of the year the patient was admitted. We hypothesized that complications following ERCPs would be greatest in the third quarter, corresponding to the beginning of the academic year for trainees. Methods: We used the National Inpatient Sample databases from the years 2008 to 2012 to identify patients that underwent ERCP using the International Classification of Diseases, Ninth Edition, Clinical Modification codes. Data points that did not contain the admission month were excluded from the study. January, February, and March were re-coded as first quarter. April, May, and June were re-coded as second quarter. July, August, and September were re-coded as third quarter. Finally, October, November, and December were re-coded as fourth quarter. Patients who experienced GI bleed, perforation, cholecystitis or mortality following ERCP were then identified. ANOVA analysis was performed in STATA to calculate differences in complication rates between quarters of the year. Results: 274,807 ERCP cases were included in our study population which represented a 20% sample of the United States. Cholecystitis rates were highest in the third quarter, 0.35%, versus 0.32%, 0.31%, and 0.32% in the first, second, and fourth quarters, respectively (p-value 0.118). Mortality rates and infection rates were highest in the fourth quarter, (1.49% p-value<0.001; 10.77% p-value<0.001, respectively), when compared to the rest of the year. No difference was seen in rates of GI bleed and perforation. Patients admitted in the third quarter were older (59.6 years old, p-value<0.001), had a longer length of stay (6.6 days, p-value 0.003), and had a higher Elixhauser Comorbidity Score (2.2, p-value<0.001) when compared to the rest of the year. Conclusion: Although post-ERCP cholecystitis rates were highest in the third quarter, other complications, including mortality, did not have any association with the start of the academic year for new trainees. Interestingly, patients admitted in the third quarter were older and had a higher Elixhauser Comorbidity Score.2835_A Figure 1. Multivariable regression model of post-ERCP GI bleed, perforation, cholecystitis and mortality rates based on admission quarter2835_B Figure 2. Comparison of complication rates by admission quarter using one-way ANOVA
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,010 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».