Coté, Gregory A.Imler, Timothy D.Xu, HuipingTeal, EvgeniaFrench, Dustin D.Imperiale, Thomas F.Rosenman, Marc B.Wilson, Jeffrey S.Hui, Siu L.Sherman, Stuart2016-03-312016-03-312013-12Coté, G. A., Imler, T. D., Xu, H., Teal, E., French, D. D., Imperiale, T. F., … Sherman, S. (2013). Lower Provider Volume is Associated with Higher Failure Rates for Endoscopic Retrograde Cholangiopancreatography. Medical Care, 51(12), 10.1097/MLR.0b013e3182a502dc. http://doi.org/10.1097/MLR.0b013e3182a502dc1537-1948https://hdl.handle.net/1805/9153BACKGROUND: Among physicians who perform endoscopic retrograde cholangiopancreatography (ERCP), the relationship between procedure volume and outcome is unknown. OBJECTIVE: Quantify the ERCP volume-outcome relationship by measuring provider-specific failure rates, hospitalization rates, and other quality measures. RESEARCH DESIGN: Retrospective cohort. SUBJECTS: A total of 16,968 ERCPs performed by 130 physicians between 2001 and 2011, identified in the Indiana Network for Patient Care. MEASURES: Physicians were classified by their average annual Indiana Network for Patient Care volume and stratified into low (<25/y) and high (≥25/y). Outcomes included failed procedures, defined as repeat ERCP, percutaneous transhepatic cholangiography or surgical exploration of the bile duct≤7 days after the index procedure, hospitalization rates, and 30-day mortality. RESULTS: Among 15,514 index ERCPs, there were 1163 (7.5%) failures; the failure rate was higher among low (9.5%) compared with high volume (5.7%) providers (P<0.001). A second ERCP within 7 days (a subgroup of failure rate) occurred more frequently when the original ERCP was performed by a low-volume (4.1%) versus a high-volume physician (2.3%, P=0.013). Patients were more frequently hospitalized within 24 hours when the ERCP was performed by a low-volume (28.3%) versus high-volume physician (14.8%, P=0.002). Mortality within 30 days was similar (low=1.9%, high=1.9%). Among low-volume physicians and after adjusting, the odds of having a failed procedure decreased 3.3% (95% confidence interval, 1.6%-5.0%, P<0.001) with each additional ERCP performed per year. CONCLUSIONS: Lower provider volume is associated with higher failure rate for ERCP, and greater need for postprocedure hospitalization.en-USPublisher PolicyCholangiopancreatography, Endoscopic Retrogradestatistics & numerical dataGastroenterologyArticle