S932 Outcomes of Endoscopic Procedures in Patients With High-Risk Cardio-Pulmonary Disease: A Population-Based Study
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".