Case volume and outcome of endoscopic retrograde cholangiopancreatography: results of a nationwide Austrian benchmarking project

Background and study aim: In a quality assessment project for endoscopic retrograde cholangiopancreatography (ERCP), initiated in 2006 by the Austrian Society of Gastroenterology and Hepatology, benchmark data were collected on a voluntary basis. Results from the individual participating centers, both academic and community-based, were compared with pooled benchmark data, with the intention that individual problems should be identified and corrected in order to improve patient care in Austria. Success and complication rates in nonselected patients were evaluated, especially with regard to case Volume. Methods: In Austria, with a population of 8 million, 140 sites are registered for ERCP, and it is estimated that up to 15000 procedures are done annually. Of these sites, 28 participated in the Benchmarking ERCP project during the first year, reporting on 3132 procedures, or 22% of the total number. Results: The overall complication rate in nonselected patients was 12.6%, consisting of post-ERCP pancreatitis (5.1%), bleeding (3.7%), cholangitis (1.9%), cardiopulmonary complications (0.9%), and perforation (0.5%); procedure-related mortality was 0.1%. The overall therapeutic and diagnostic target was achieved in 84.8%. High case volume (endoscopists performing > 50 vs. < 50 ERCPs per year; 21 vs. 68 endoscopists) was associated with significantly higher success (86.9% vs. 80.3%, P < 0.001) and lower overall complication rates (10.2% vs. 13.6%, P=0.007); significance was not reached for all subgroups of complications. Conclusion: Success and complication rates for ERCP in Austria are comparable to those reported elsewhere. In our study, endoscopists with a case volume exceeding 50 ERCPs per year had higher success and lower overall complication rates.