Lower provider volume is associated with higher failure rates for endoscopic retrograde cholangiopancreatography

Gregory A. Coté*, Timothy D. Imler, Huiping Xu, Evgenia Teal, Dustin D. French, Thomas F. Imperiale, Marc B. Rosenman, Jeffery Wilson, Siu L. Hui, Stuart Sherman

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

56 Scopus citations


BACKGROUND: 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.

Original languageEnglish (US)
Pages (from-to)1040-1047
Number of pages8
JournalMedical care
Issue number12
StatePublished - Dec 2013


  • ERCP quality
  • gastroenterology
  • outcomes

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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