S932 Outcomes of Endoscopic Procedures in Patients With High-Risk Cardio-Pulmonary Disease: A Population-Based Study

Introduction: High-risk cardiopulmonary disease including heart failure [HF] and pulmonary hypertension, [PH] are associated with high inpatient mortality and morbidity. Endoscopic procedures including EGD, colonoscopy and ERCP are generally well tolerated. However, outcomes in patients with cardiopulmonary disease have not been thoroughly studied at a population-level. We aim to evaluate the safety outcomes among patients undergoing common inpatient gastrointestinal procedures. Methods: The National Inpatient Sample database, 2016-2021 was used to extract patients who underwent EGD, colonoscopy or ERCP. Patients with HF and PH undergoing above endoscopic procedures were identified. The primary outcome was all-cause mortality. Secondary outcomes included cardiac arrest, cardiogenic shock, prolonged length of stay, and mechanical ventilation. Regression analyses were used to compare outcomes. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were reported. P < 0.05 was considered statistically significant. Results: A total of 81,725 HF and PH patients who underwent endoscopic intervention were identified. There was a higher proportion of females (55%, P< 0.001). Patients with HF and PH who underwent EGD had higher rates of inpatient mortality (aOR 1.106, CI 1.01-1.22; P=0.043), cardiac arrest (aOR 1.367, CI 1.18-1.57, P=0.019), cardiogenic shock (aOR 12.426, CI 10.68-4.45, P< 0.001) and prolonged length of stay (aOR 1.610 CI 1.54-1.68, P< 0.001) but similar rate of mechanical ventilation). Similarly, in patients who underwent colonoscopy, patients with HF and PH had higher rates of cardiac arrest (aOR 1.80 CI 1.42-2.27, P=0.036); cardiogenic shock (aOR 24.83 CI 19.05-32.37, P< 0.001) and prolonged length of stay (aOR 1.64, CI 1.55-1.74, P< 0.001) but similar mortality and mechanical ventilation. In contrast, there was no difference in outcomes among the 2 groups of patients who underwent ERCP. With all procedures combined, patients with high-risk cardiopulmonary disease had higher rate of mortality, cardiac arrest, cardiogenic shock and prolonged length of stay but similar mechanical ventilation rates (Table 1). Conclusion: EGD is associated with increased risk of mortality among patients with high-risk cardiopulmonary disease while colonoscopy and ERCP did not increase risk of death. Odds of cardiac arrest, cardiogenic shock and prolonged length of stay were higher among patients receiving EGD and colonoscopy. However, these negative outcomes were not observed in patients undergoing ERCP. Table 1. - Safety outcomes of endoscopic procedures in patients undergoing EGD, colonoscopy and ERCP aOR (95% CI) P-value Esophagogastroduodenoscopy Mortality 1.106 (1.01-1.22) 0.043 Cardiac Arrest 1.367 (1.18-1.57) 0.019 Cardiogenic shock 12.426 (10.68-4.45) <0.001 Prolonged length of Stay 1.610 (1.54-1.68) <0.001 Mechanical ventilation 1.036 (0.96-1.11) 0.234 Colonoscopy Mortality 1.15 (0.98-1.35) 0.583 Cardiac Arrest 1.80 (1.42-2.27) 0.036 Cardiogenic Shock 24.83 (19.05-32.37) <0.001 Prolonged length of stay 1.64 (1.55-1.74) <0.001 Mechanical ventilation 1.11 (0.98-1.26) 0.264 Endoscopic Retrograde Cholangiopancreatography Mortality 1.766 (0.82-3.79) 0.380 Cardiac Arrest 2.967 (0.89-9.87) 0.524 Cardiogenic shock 9.283 (1.81-47.53) 0.224 Prolonged length of stay 1.615 (1.04-2.50) 0.132 Mechanical ventilation 1.977 (1.04-3.77) 0.694 Combined EGD, colonoscopy and ERCP Mortality 1.122 (1.03-1.22) 0.030 Cardiac arrest 1.405 (1.23-1.60) 0.008 Cardiogenic shock 15.892 (13.79-18.31) <0.001 Prolonged length of stay 1.607 (1.55-1.67) <0.001 Mechanical ventilation 1.049 (0.98-1.12) 0.103

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