Impact of atrial fibrillation in hospitalized patients undergoing endoscopic retrograde cholangiopancreatography: A nationwide analysis.

Background: Atrial fibrillation (AF) remains the most common cardiac arrhythmia. The safety of endoscopic retrograde cholangiopancreatography (ERCP) in patients with AF remains largely unknown.

Aim: To analyze the effect of AF on hospital outcomes in patients undergoing ERCP.

Methods: We performed a retrospective cohort study using the Nationwide Inpatient Sample database. Adult patients with AF who underwent an inpatient ERCP were identified, then stratified by timing of ERCP, international classification of diseases-10 codes. The primary outcome was all-cause in-hospital mortality. Secondary outcomes, including resource utilization, were assessed. Statistical analysis was performed using STATA software.

Results: Of the 433245 patients that underwent an ERCP, 49615 had a diagnosis of AF. Patients with AF had a significantly higher in-hospital mortality compared to those without AF [3.82% 1.13%, odds ratio (OR) = 1.93, < 0.01]. AF was significantly associated with increased hospital stay (+1.71 days), hospital charges ($21210), shock (OR = 2.17), sepsis (OR = 1.34), intensive care unit admission (OR = 2.41), acute kidney injury (OR = 1.51), as well as a decreased likelihood of discharge to home (OR = 0.59), (all with < 0.01). These results were consistent after propensity score matching. Upon subgroup analysis, patients with AF, whom underwent ERCP > 72 hours, had worse outcomes including higher in-hospital mortality (adjusted OR = 1.47, < 0.01).

Conclusion: By way of this large, national analysis it appears AF is associated with significantly worse hospitalization outcomes, inducing increased mortality, in those undergoing ERCP. Further prospective investigation is warranted to potentially guide clinical recommendations for patients with AF undergoing ERCP in this setting.