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

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 procedure-related 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.