Quality indicators, including complications, of ERCP in a community setting: a prospective study.

摘要

BACKGROUND: There are no large studies documenting quality outcomes and complication rates of ERCP in community practice. The American Society for Gastrointestinal Endoscopy (ASGE)/American College of Gastroenterology Task Force on Quality proposed 5 questions regarding ERCP in community practice. The ASGE Committee on Outcomes Research recommended 8 ERCP-specific quality indicators be used to provide a better accounting of quality in ERCP. OBJECTIVE: To determine ERCP quality outcomes, including complications, in a community practice. DESIGN: Prospective study. SETTING: Eight community hospitals in the Minneapolis-St. Paul, Minnesota, area. PATIENTS: Every patient undergoing ERCP by Minnesota Gastroenterology PA from December 1, 2005, through July 31, 2006. MAIN OUTCOME MEASUREMENTS: ASGE-recommended quality indicators, especially 30-day complication rates. RESULTS: A total of 805 ERCP procedures were performed in 696 patients. Therapeutic ERCP accounted for 78.4%. The complication rate was 5.0% (5.7% of therapeutic and 2.3% of diagnostic procedures). Pancreatitis occurred in 3.2% of procedures (3.6% of therapeutic and 1.7% of diagnostic procedures). Infection (0.75%), hemorrhage (0.62%), and perforation (0.12%) only occurred after therapeutic ERCP. Cardiopulmonary complications occurred in 2 patients (0.25%). Precut sphincterotomy was performed in 26 cases (3.2%), and sphincter of Oddi manometry in 23 cases (2.9%). Success rates were 94.0% for biliary cannulation, 87.0% for stone extraction, and 90.2% for relieving biliary obstruction. A total of 530 patient satisfaction surveys were completed and revealed that the response to the question, "Would you have the procedure done again by this physician?" was the most sensitive indicator of patient satisfaction. CONCLUSIONS: In this community practice, complication rates compare very favorably with those of academic centers. The technical success rates achieved or exceeded rates recommended by the ASGE/American College of Gastroenterology Task Force.