P4104 - Outcomes of Endoscopic Procedures in Patients With High-Risk Cardio-Pulmonary Disease: A Population-Based Study

Chukwunonso Ezeani, MBBS¹, Oyedotun Babajide, MD², Chukwuemeka E. Ogbu, MD, MPH³, Bishoy Lawendy, MD⁴, Michael Youssef, MD⁵, Deborah Adekunle, MD⁶, Muni Rubens, MD⁷, Philip Okafor, MD, MPH^8
1Baton Rouge General Medical Center, Baton Rouge, LA; ²New York Medical College Metropolitan Hospital, New York, NY; ³Cape Fear Valley Health, Fayetteville, NC; ⁴Western University, London, ON, Canada; ⁵University of Toronto, Ontario, ON, Canada; ⁶Washington University School of Medicine in St. Louis / Barnes-Jewish Hospital, St. Louis, MO; ⁷Miami Cancer Institute, Miami, FL; ⁸Mayo Clinic, Jacksonville, FL

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 two 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)

Discussion: 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.


Disclosures:


Chukwunonso Ezeani, MBBS¹, Oyedotun Babajide, MD², Chukwuemeka E. Ogbu, MD, MPH³, Bishoy Lawendy, MD⁴, Michael Youssef, MD⁵, Deborah Adekunle, MD⁶, Muni Rubens, MD⁷, Philip Okafor, MD, MPH⁸. P4104 - Outcomes of Endoscopic Procedures in Patients With High-Risk Cardio-Pulmonary Disease: A Population-Based Study, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.