PMID- 10228255
OWN - NLM
STAT- MEDLINE
DCOM- 19990616
LR  - 20190722
IS  - 0016-5107 (Print)
IS  - 0016-5107 (Linking)
VI  - 49
IP  - 5
DP  - 1999 May
TI  - Same-day discharge after endoscopic biliary sphincterotomy: observations from a 
      prospective multicenter complication study. The Multicenter Endoscopic 
      Sphincterotomy (MESH) Study Group.
PG  - 580-6
AB  - BACKGROUND: Same-day discharge after endoscopic biliary sphincterotomy (ES) is a 
      common clinical practice, but there have been few data to guide appropriate 
      selection of patients. Using a prospective, multicenter database of 
      complications, we examined outcomes after same-day discharge as it was practiced 
      by a variety of endoscopists and evaluated the ability of a multivariate risk 
      factor analysis to predict which patients would require readmission for 
      complications. METHODS: A 150-variable database was prospectively collected at 
      time of ES, before discharge and again at 30 days in consecutive patients 
      undergoing ES at 17 centers. Complications were defined by consensus criteria and 
      included all specific adverse events directly or indirectly related to ES 
      requiring more than 1 night of hospitalization. RESULTS: Six hundred fourteen 
      (26%) of 2347 patients undergoing ES were discharged on the same day as the 
      procedure, ranging from none at 6 centers to about 50% at 2 centers. After 
      initial observation and release, readmission to the hospital for complications 
      occurred in 35 (5.7%) of 614 same-day discharge patients (20 pancreatitis and 15 
      other complications, 3 severe). Of the same-day discharge patients, readmission 
      was required for 14 (12.2%) of 115 who had at least one independently significant 
      multivariate risk factor for overall complications (suspected sphincter of Oddi 
      dysfunction, cirrhosis, difficult bile duct cannulation, precut sphincterotomy, 
      or combined percutaneous-endoscopic procedure) versus 21 (4.2%) of 499 without a 
      risk factor (odds ratio 3.1: 95% confidence interval [1.6, 6.3], p < 0.001). Of 
      complications presenting within 24 hours after ES, only 44% presented within the 
      first 2 hours, but 79% presented within 6 hours. CONCLUSIONS: Same-day discharge 
      is widely utilized and relatively safe but results in a significant number of 
      readmissions for complications. For patients at higher risk of complications, as 
      indicated by the presence of at least one of five independent predictors, 
      observation for 6 hours or overnight may reduce the need for readmission.
FAU - Freeman, M L
AU  - Freeman ML
AD  - Hennepin County Medical Center and Minneapolis Veterans Administration Medical 
      Center, MN 55415, USA.
FAU - Nelson, D B
AU  - Nelson DB
FAU - Sherman, S
AU  - Sherman S
FAU - Haber, G B
AU  - Haber GB
FAU - Fennerty, M B
AU  - Fennerty MB
FAU - DiSario, J A
AU  - DiSario JA
FAU - Ryan, M E
AU  - Ryan ME
FAU - Kortan, P P
AU  - Kortan PP
FAU - Dorsher, P J
AU  - Dorsher PJ
FAU - Shaw, M J
AU  - Shaw MJ
FAU - Herman, M E
AU  - Herman ME
FAU - Cunningham, J T
AU  - Cunningham JT
FAU - Moore, J P
AU  - Moore JP
FAU - Silverman, W B
AU  - Silverman WB
FAU - Imperial, J C
AU  - Imperial JC
FAU - Mackie, R D
AU  - Mackie RD
FAU - Jamidar, P A
AU  - Jamidar PA
FAU - Yakshe, P N
AU  - Yakshe PN
FAU - Logan, G M
AU  - Logan GM
FAU - Pheley, A M
AU  - Pheley AM
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Gastrointest Endosc
JT  - Gastrointestinal endoscopy
JID - 0010505
SB  - IM
CIN - Gastrointest Endosc. 1999 May;49(5):660-2. PMID: 10228274
MH  - Adult
MH  - Aged
MH  - Ambulatory Surgical Procedures/*adverse effects/statistics & numerical data
MH  - Canada/epidemiology
MH  - Cholangiopancreatography, Endoscopic Retrograde/adverse effects/statistics & 
      numerical data
MH  - Cohort Studies
MH  - Humans
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - *Patient Discharge/statistics & numerical data
MH  - Patient Readmission/statistics & numerical data
MH  - Postoperative Complications/*epidemiology/etiology
MH  - Prospective Studies
MH  - Risk Factors
MH  - Sphincterotomy, Endoscopic/*adverse effects/statistics & numerical data
MH  - Time Factors
MH  - Treatment Outcome
MH  - United States/epidemiology
EDAT- 1999/05/06 00:00
MHDA- 1999/05/06 00:01
CRDT- 1999/05/06 00:00
PHST- 1999/05/06 00:00 [pubmed]
PHST- 1999/05/06 00:01 [medline]
PHST- 1999/05/06 00:00 [entrez]
AID - S0016-5107(99)70385-8 [pii]
AID - 10.1016/s0016-5107(99)70385-8 [doi]
PST - ppublish
SO  - Gastrointest Endosc. 1999 May;49(5):580-6. doi: 10.1016/s0016-5107(99)70385-8.