{"paper_id":"375c1174-7cc8-4e5c-b439-81efebb98ab0","body_text":"Frailty as a Predictor of Outcomes in Patients with Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Frailty as a Predictor of Outcomes in Patients with Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis Camilo J Acosta, Sunil Amin, Jodie A. Barkin This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6291035/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract BACKGROUND The development of acute pancreatitis is the most common serious complication of endoscopic retrograde cholangiopancreatography (ERCP). AIMS We aimed to determine the association between frailty status and outcomes in patients with post-ERCP pancreatitis (PEP). METHODS We performed a cohort study using merged data from the 2016 and 2017 National Inpatient Sample (NIS) database. International Classification of Diseases (ICD), Tenth Revision, Clinical Modification (ICD-10-CM) and Procedure Coding system (ICD-10-PCS) diagnostic codes were utilized to identify adult patients with PEP. Using a validated frailty definition based on ICD codes known as the Hospital Frailty Risk Score (HFRS), we then classified patients as frail versus non-frail in this selected population. Primary outcomes were pancreatitis-related and peri-procedural complications including all-cause mortality. Secondary outcomes were length of stay and total hospitalization costs. We constructed multivariable logistic regression models, adjusting for clinically pertinent confounders (i.e., age, sex, comorbidities using the Charlson Comorbidity Index) to determine the association between frailty and PEP complications. RESULTS There were 41,615 patients represented in the data, with 34.6% (14,382) characterized as frail and 65.4% (27,233) as non-frail. 60.7% of frail patients suffered composite complications related to PEP compared to 29.3% of non-frail patients (P < 0.001). Frail patients had more cardiovascular, pulmonary, gastrointestinal, renal and endocrine, neurologic, and infectious complications compared to non- frail patients. Frail patients also had higher all-cause mortality rates during inpatient admission (4.6% vs under 0.1%, P < 0.001) and increased length of stay (11.6 days vs 0.8, P < 0.001) as well total hospitalization charges ($140,855 vs $73,539, P < 0.001). On multivariable analysis, positive frailty status was associated with 2.94 times increased odds of having composite complications. CONCLUSION In hospitalized patients with post-ERCP pancreatitis, frailty status is associated with increased complications including all-cause mortality during hospitalization. Frail patients with PEP also have increased length of stay and total hospitalization costs during admission. Frailty assessments can thus be utilized as a predictor of outcomes and serve to guide clinical decision-making when determining prophylactic measures in patients undergoing ERCP who may be at risk for PEP. Frail Pancreas Outcomes Post-endoscopic retrograde cholangiopancreatography pancreatitis Frailty Pancreatitis Figures Figure 1 Figure 2 Core tip This is a retrospective cohort study to investigate the association between frailty and outcomes in patients with post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). Of 41,615 patients represented in the data, 60.7% of frail patients suffered composite complications related to PEP compared to 29.3% of non-frail patients including cardiovascular, pulmonary, gastrointestinal, renal and endocrine, neurologic, and infectious complications. Frail patients also had higher all-cause mortality rates during inpatient admission, increased length of stay, and total hospitalization charges. Frailty assessment can thus be used to further guide clinical decision-making as a risk stratification tool when determining to pursue preventive methods for PEP. INTRODUCTION Endoscopic retrograde cholangiopancreatography (ERCP) carries a post-ERCP pancreatitis (PEP) rate of 2–10%, which can be as high as 30–50% in high-risk cases. [ 1 ] It remains as the most common and most severe complication related to ERCP. [ 2 ] In up to 5% of PEP cases, there can be potential for life-threatening complications, including multi-organ failure, peripancreatic fluid collections, and death with a mortality rate that can reach 1%. [ 1 , 2 ] There are various measures employed to prevent PEP as a complication including pharmacologic and endoscopic methods with varying success. These include the use of peri-procedural intravenous fluids, rectal indomethacin, and pancreatic stent placement. Deciding when to use these preventive techniques becomes an important question, in order to provide the most appropriate peri-procedural management and consequently minimize likelihood of PEP. [ 3 ] In this regard, studies have shown various patient-related factors that increase risk of PEP to be suspected sphincter of Oddi dysfunction (SOD), female gender, previous pancreatitis, previous PEP, non-dilated common bile duct, normal bilirubin, younger age, and end stage renal disease. [ 4 , 5 , 6 , 7 ] Procedure-related risk factors include overmanipulating the papilla, difficult cannulation, and the degree of pancreatic duct (PD) manipulation. [ 1 , 8 , 9 ] One predictor that remains understudied in patients with PEP is frailty status. Frailty is defined as a clinical syndrome characterized by an increased state of vulnerability due a decline in function across several organ systems, that is associated with an increased risk of poor outcomes in individuals exposed to an apparently innocuous stressor. [ 10 ] Literature on this topic has grown considerably over the last 10–15 years that has demonstrated the utility of frailty status as a strong predictor of adverse events and complications related to various procedures including pancreatoduodenectomy or pancreatic resection, kidney transplant, percutaneous coronary intervention, and colectomy. [ 11 – 16 ] There is only one prior study that has evaluated the impact of frailty on outcomes after ERCP, however. By using the Johns Hopkins’s adjusted clinical groups (ACG) frailty indicator system, the authors found frailty status to be associated with worse outcomes such as heightened mortality, prolonged hospital stays, and increased healthcare costs in nonagenarian patients after ERCP. [ 17 ] Despite the development and validation of various frailty measurement tools, the majority are too complex for use in the acute care setting or require some form of manual evaluation process that becomes a deterrent for use in hospitalized patients. The Hospital Frailty Risk Score (HFRS) is a predictive tool based on ICD-10 codes that was developed in the United Kingdom and validated against two prominent clinical measures of frailty: the Fried Phenotype and Rockwood Frailty Index. [ 18 ] As defined by the HFRS, frailty has been demonstrated to be a predictor of poor clinical outcomes for patients with inflammatory bowel disease, heart failure, acute myocardial infarction, and pneumonia as well as those undergoing total hip and knee arthroplasty, percutaneous coronary intervention, spinal surgery, and cardiac arrest in separate investigations. [ 19 – 25 ] We have also published two separate studies demonstrating that positive frailty status, as defined by the HFRS, is associated with increased peri-procedural complication risk in patients with gastrointestinal bleeding who undergo endoscopy and with worse clinical outcomes in patients admitted with acute pancreatitis. [ 26 , 27 ] The aim of our study was to use the HFRS to determine the association between frailty status and risk of adverse events in hospitalized patients with post-ERCP pancreatitis. We hypothesized frailty would be a strong indicator of adverse events and all-cause mortality as well as secondary outcomes (length of stay and hospitalization charges) among this patient population. MATERIALS AND METHODS Data Source Data was obtained from the National Inpatient Sample (NIS), which is the largest publicly available all-payer inpatient database available in the United States and forms part of the Healthcare Cost and Utilization Project (HCUP). This database represents approximately 20% of the stratified sample of U.S. nonfederal acute care hospitals. The NIS contains both patient- and hospital-level information (including demographic variables, primary and secondary diagnoses, discharge disposition, primary and secondary procedures, etc.), with safeguards to protect the privacy of patients, physicians, and hospitals. As such, de-identified data was used in this study that did not require institutional review board approval. Study population Appended data were used from the HCUP NIS for the years 2016-2017. 28 International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnostic codes were utilized to identify adult patients with post-ERCP pancreatitis during admission. This was based on a methodology that was used and validated previously. [29-32] This method includes differentiating between acute pancreatitis at admission from PEP. In brief, patients who underwent ERCP after the day of admission and had a diagnosis of acute pancreatitis that was not a primary diagnosis (therefore patients who were not admitted with acute pancreatitis due to a different etiology) were classified as patients with PEP. ICD-9 codes used in previous studies were mapped to corresponding ICD-10 codes (Appendix). Patients were excluded if they were younger than 18 years of age or if there was missing date on age or gender. Study variables Demographic information including age, sex, race, median annual income in patient’s zip code, and hospital region were provided within the NIS for each hospitalization, along with length of stay and total hospitalization charges per admission. Comorbid conditions were recorded if they were listed among the discharge diagnoses and the Charlson Comorbidity Index (CCI) was used to assess the burden of comorbid disease, utilizing a validated ICD-10 coding scheme that builds on Deyo’s adaptation and Quan’s algorithm of the CCI for use with contemporary U.S. databases. [33] Definition of frailty Frailty was defined using a previously validated algorithm of ICD-10 codes, known as the Hospital Frailty Risk Score (HFRS). This score was developed by Gilbert et al. via a cluster analysis of British adults 75 years and older, who had diagnoses in electronic medical records that were associated with frailty and high resource utilization. [18] The HFRS was then derived from an aggregate of 109 ICD-10 codes that were over-represented in this cluster with each code awarded specific values proportional to how strongly they predicted frailty. These codes are inclusive primarily of neurologic (i.e., dementia, intracranial injury, abnormal gait), endocrine (i.e., vitamin deficiencies, thyrotoxicosis), renal (i.e., acute and chronic renal failure), genitourinary (i.e., urinary incontinence or retention, urinary tract infection), soft tissue/skin (i.e. gangrene, ulcerations, cellulitis), and musculoskeletal (i.e. fracture, falls) conditions. In a national validation cohort of more than a million patients, a HFRS ≥ 5 was found to indicate intermediate (or greater) frailty and was associated with increased 30-day hospital readmission and increased 30-day mortality. Therefore, a cutoff of HFRS ≥ 5 was established to classify patients as frail while patients with HFRS < 5 were classified as non-frail. Using this scoring scheme, the HFRS was thereafter externally validated in a Swiss tertiary care hospital and in elderly patients in Canada, where it was found to independently predict mortality, length of stay, and 30-day readmission. [34,35] Outcomes The primary outcomes were pancreatitis-related and peri-procedural adverse events including all-cause mortality. A patient was recorded as having a pancreatitis-related or peri-procedural adverse event if any of a number of pre-defined ICD-10 codes for the aforementioned events occurred within the same admission (Appendix). These codes were based off of well-known complications of acute pancreatitis as well as established peri-procedural and postoperative adverse events. [36-42] Codes that were used for inclusion criteria to identify patients with PEP, and codes that form part of the HFRS were excluded as markers for complications. Statistical analysis All statistical analyses were performed using STATA v16.1 (College Station, Texas). [43] Sample sizes were estimated by applying the discharge weight (DISCWT) and using Stata's survey estimation command to adjust for the complex sampling design of the NIS. Demographic variables between frail and non-frail patients were compared using t-tests for continuous variables and chi-square tests for categorical variables. Univariate logistic regression analysis was used to calculate unadjusted odds ratios (ORs) for the primary outcomes. Multivariate logistic regression models were then used to adjust for clinically relevant confounders. Results were reported as adjusted odds ratios (aORs) with 95% confidence intervals (CIs) and a two-sided p-value <0.05 indicated statistical significance. Finally, marginal standardization analysis was performed to assess for possible interaction between age and frailty status. As part of this analysis, age was stratified into 10-year increments. RESULTS A total of 8,364 (weighted n = 41,615) adult patients were discharged with a diagnosis of PEP in the NIS from 2016-2017 (Figure 1). The proportion of frail vs non-frail patients was rightly distributed in a 1:2 ratio, with 34.6% (weighted n = 14,382) characterized as frail and 65.4% (weighted n = 27,233) as non-frail (Table 1). Frail patients with PEP had a significantly higher mean age than non-frail patients (68.5 years vs 55.6 years, P < 0.001). They were also found to have a significantly higher burden of comorbidities with a CCI ≥ 3 (38.7% vs 13.9%, P < 0.001) compared to those who were non-frail. Length of stay for frail patients was twice as long on average compared to non-frail patients (11.6 vs 5.8 days, P < 0.001), and total hospitalization charges incurred during admission for frail patients were approximately double the amount compared to their non-frail counterparts ($140,855 vs $73,539, P < 0.001). Composite peri-procedural adverse events and complications related to pancreatitis including all-cause inpatient mortality were found to be significantly more common among frail patients discharged with a diagnosis of PEP (60.7% vs 29.3%, P < 0.001) compared to non-frail patients (Table 2). By organ system, frail patients had more gastrointestinal (27.4% vs 17.8%, P < 0.001), cardiovascular (25.3% vs 7.3%, P < 0.001), infectious (23.9% vs 4.3%, P < 0.001), pulmonary (20.0% vs 6.4%, P < 0.001), renal and endocrine (1.2% vs 0.3%, P < 0.001), and neurologic (0.9% vs < 0.1%, P < 0.001) adverse events compared to those who were fit. With regards to all-cause in-hospital mortality, a total of 1.7% of patients in the study population died during hospitalization, accounting for an estimated 692 deaths nationwide between 2016-2017. Notably, frail patients had higher all-cause mortality rates during inpatient admission compared to non-frail patients (4.6% vs < 0.1%, P < 0.001). Despite adjusting for potential confounders, positive frailty status was associated with 2.94 times increased odds of having composite adverse events (aOR 2.94, 95% CI: 2.64-3.28, P < 0.001) (Table 3). Other predictors of complications were elevated burden of comorbidities with CCI ≥ 3 (aOR 2.92, 95% CI: 2.53-3.37), female gender (aOR 0.84, 95% CI: 0.76-0.93), and Hispanic race (aOR 0.79, 95% CI: 0.69-0.92). Complete results of the multivariable logistic regression analysis performed are shown in Table 3. On marginal standardization analysis between age and frailty status, there was a consistent rate of adverse events for frail patients irrespective of increasing age. Specifically, there was a 20-23% difference in adverse event rate between frail and non-frail patients by 10-year increments from 40 years to 90 years of age (Figure 2). DISCUSSION With the population of elderly patients rising globally, the prevalence of frailty is expected to continue to increase over time. [ 44 ] Frailty status has consequently become an increasingly relevant topic around patient risk and adverse events. [ 45 , 46 ] One area that remains understudied with regards to the impact of frailty on clinical outcomes is post-ERCP pancreatitis. Therefore, we sought to investigate in the present study the association between frailty status and complications related to PEP among hospitalized adults. Our analysis is representative of over 41,000 patients nationwide, and indicates that positive frailty status with HFRS ≥ 5 in patients with PEP is associated with increased risk of composite complications (60.7% vs 29.3%, P < 0.001) compared to non-frail patients across various organ systems including gastrointestinal (27.4% vs 17.8%, P < 0.001), cardiovascular (25.3% vs 7.3%, P < 0.001), infectious (23.9% vs 4.3%, P < 0.001), pulmonary (20.0% vs 6.4%, P < 0.001), renal and endocrine (1.2% vs 0.3%, P < 0.001), and neurologic (0.9% vs < 0.1%, P < 0.001) adverse events. Moreover, in terms of infectious complications, frail patients have a higher proportion of sepsis and severe sepsis events than non-frail patients (22.0% vs 2.7%, P < 0.001). Mortality during admission was significantly higher among frail patients, with nearly a 25-fold increased proportion of patients suffering from in-hospital death. Finally, length of stay was significantly longer for frail patients with close to an additional six days of inpatient admission required, and total hospitalization charges during inpatient stay for frail patients were significantly higher, totaling over $ 140,000 compared to under $ 74,000 for non-frail patients. Comorbidity burden (as assessed by the Charlson Comorbidity Index) was positively associated with adverse event risk, which was an expected finding, in addition to female gender and Hispanic race. Accordingly, we ensured to correct for these confounders in our multivariable analysis which showed frailty is affiliated with increased complication risk independent of CCI, gender, or race. Increasing age was not found to be a significant predictor of composite complications, which is in line with prior studies that have actually demonstrated younger age to be an independent risk factor for PEP. [ 3 – 7 , 47 ] Notwithstanding, to rule out any possible interaction between age and frailty status, we performed marginal standardization analysis. This analysis showed frailty was associated with a consistent rate in adverse events in relation to age, indicating that age alone cannot explain our findings (Fig. 2 ). These results suggest an important benefit of frailty assessment as a risk stratification tool in patients undergoing ERCP who are at risk for PEP and PEP-related adverse complications. In this light, our results affirm the value of frailty evaluation as an independent tool to help guide medical decision-making when determining whether to employ preventive and prophylactic methods for PEP. Our findings are consistent with the only similar investigation reported by Basida et al. who demonstrated that frail nonagenarians undergoing ERCP had heightened mortality, prolonged hospital stays, and increased healthcare costs compared to non-frail counterparts. [ 17 ] In their retrospective analysis, patients between 90 and 99 years old were categorized as frail or non-frail according to the Johns Hopkins’s adjusted clinical groups (ACG) frailty indicator system, which is similar to the HFRS in the sense that it relies on diagnosis codes. The present study has several limitations; however, many of these are due to the inherent nature of population-based datasets. We have attempted to overcome these issues as best as possible through rigorous statistical methodology. First, the NIS data lack the clinical detail available in other study designs and in general clinical practice (vital signs, lab values, pharmacotherapy). Such data are useful for denoting the severity of underlying disease and for confirming the presence of comorbid conditions and adverse events. In this regard, we were able to apply a validated general prognostic scale, the Charlson Comorbidity Index, to effectively assess the burden of comorbid illness. Second, the use of ICD-10 codes to establish diagnoses, procedures, and adverse events can result in the misclassification or underreporting of the aforementioned. Nevertheless, the reliability of administrative codes in identifying patients with PEP has been shown to be high and validated in previous studies. [ 29 – 32 ] Third, the retrospective nature of this study only allows for associational rather than causational conclusions, but the use of data from a nationwide population-based sample still provides strong evidence for generalizing these observations to national clinical practice in the United States. Finally, the actual cause of death is not captured in the NIS, so we reported total all-cause inpatient mortality, which is in agreement with other investigations examining mortality in patients with PEP. [ 29 – 32 ] In conclusion, these data suggest that frailty status is associated with increased adverse events and complications including all-cause mortality during hospitalization for patients with PEP. The use of frailty evaluation can thus further guide clinical decision-making as a risk stratification tool when balancing the utility of preventive and prophylactic methods for PEP, including rectal indomethacin, intravenous fluids, and/or pancreatic stenting. These interventions have proven benefits particularly in high-risk patients, yet their widespread use in the United States and North America remains suboptimal for a variety of reasons. [ 48 ] Frailty assessment can therefore be a key proactive resource of substantial importance in guiding early interventions for patients at risk of worse outcomes related to PEP. While the HFRS is a robust frailty measure, calculating this score involves a large number of administrative codes, and it is not incorporated into current hospital-based digital platforms. Future efforts should hence be focused on translating the HFRS into a more simplistic, readily available tool and the development of a rapid clinical calculator to aid in the decision-making process of management of patients with or at risk for PEP due to frailty status to minimize the impact and incidence of PEP in this population, and reduce PEP-associated morbidity and mortality. Declarations Author Contribution Camilo J. Acosta study concept and design, acquisition of data, statistical analysis and interpretation of data; drafting and critical revision of the manuscript. Sunil Amin study concept and design, acquisition of data, statistical analysis and interpretation of data; critical revision of the manuscript for important intellectual concept.Jodie A. Barkin study concept and design, statistical analysis and interpretation of data, critical revision of the manuscript for important intellectual concept. ACKNOWLEDGEMENTS None of the listed authors have any conflicts of interest to disclose. Financial support: None. Potential competing interests: None. References Cahyadi O, Tehami N, de-Madaria E, Siau K. Post-ERCP Pancreatitis: Prevention, Diagnosis and Management. Medicina (Kaunas) . 2022;58(9):1261. Published 2022 Sep 12. doi:10.3390/medicina58091261 Arata S, Takada T, Hirata K, et al. Post-ERCP pancreatitis. 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College Station, TX: StataCorp LLC Hoogendijk EO, Afilalo J, Ensrud KE, et al. Frailty: implications for clinical practice and public health. The Lancet. 2019;394(10206):1365-1375. Robinson TN, Walston JD, Brummel NE, et al. Frailty for Surgeons: Review of a National Institute on Aging Conference on Frailty for Specialists. J Am Coll Surg. 2015;221(6):1083-1092. Walston J, Robinson TN, Zieman S, et al. Integrating Frailty Research into the Medical Specialties-Report from a U13 Conference. J Am Geriatr Soc. 2017;65(10):2134-2139. Losurdo G, Iannone A, Principi M, et al. Acute pancreatitis in elderly patients: A retrospective evaluation at hospital admission. European Journal of Internal Medicine. 2016;30:88-93. Buxbaum JL, Freeman M, Amateau SK, et al. American Society for Gastrointestinal Endoscopy guideline on post-ERCP pancreatitis prevention strategies: summary and recommendations. Gastrointest Endosc . 2023;97(2):153-162. doi:10.1016/j.gie.2022.10.005 Tables Table 1. Demographic characteristics of adult patients with post-ERCP pancreatitis (n = 41,615) Characteristic Frail (n = 14,382) Non-frail (n = 27,233) P value Age, mean (SD) 68.5 (16.2) 55.6 (19.3) <0.001 Sex, no. (%) <0.001 Male 6,820 (47.4) 10,628 (39.0) Female 7,562 (52.6) 16,605 (61.0) Race, no. (%) <0.001 White 9,935 (69.1) 17,326 (63.6) Black 1,343 (9.3) 2,292 (8.4) Hispanic 1,884 (13.1) 5,235 (19.3) Asian or Pacific Islander 643 (4.5) 1,061 (3.9) Native American 93 (0.6) 253 (0.9) Other 484 (3.4) 1,066 (3.9) Median annual income in patient’s zip code, USD, no. (%) 0.310 Quartile 1 (1-42,999 in 2016 and 1-43,999 in 2017) 4,159 (28.9) 7,705 (28.3) Quartile 2 (43,000-53,999 in 2016 and 44,000-55,999 in 2017) 3,705 (25.8) 6,972 (25.6) Quartile 3 (54,000-70,999 in 2016 and 56,000-73,999 in 2017) 3,408 (23.7) 6,941 (25.5) Quartile 4 (≥ 71,000 in 2016 and ≥ 74,000 in 2017) 3,110 (21.6) 5,616 (20.6) Insurance type, no. (%) <0.001 Medicare 9,588 (66.7) 10,164 (37.3) Medicaid 1,498 (10.4) 5,040 (18.5) Private 2,554 (17.8) 9,427 (34.6) Self-pay 408 (2.8) 1,630 (6.0) No charge 30 (0.2) 184 (0.7) Other 304 (2.1) 788 (2.9) Hospital region, no. (%) 0.586 Northeast 1,836 (20.6) 4.797 (17.6) Midwest 1,969 (22.0) 5,672 (20.9) South 3,250 (36.4) 9,892 (36.3) West 1,875 (21.0) 6,872 (25.2) Length of stay in days, mean (SD) 11.6 (12.5) 5.8 (4.4) <0.001 Total hospitalization charges in USD, mean (SD) $140,855 ($179,991) $73,539 ($61,162) <0.001 Charlson Comorbidity Index <0.001 0 2,821 (19.6) 14,002 (51.4) 1 3,358 (23.3) 6,319 (23.2) 2 2,646 (18.4) 3,125 (11.5) ≥ 3 5,557 (38.7) 3,787 (13.9) Note : Frail is defined as the presence of a HFRS (Hospital Frailty Risk Score) ≥ 5 based on validated International Classification of Diseases (ICD) codes to identify frail individuals in electronic medical records. Non-frail is defined as the presence of a HFRS < 5 based on validated ICD codes to identify frailty. Abbreviations: ERCP, Endoscopic Retrograde Cholangiopancreatography, SD, standard deviation Table 2. Difference in Peri-procedural Complications between Frail and Non-frail patients with post-ERCP pancreatitis Complications, no (%) Frail (n = 14,382) Non-frail (n = 27,233) P value Composite 8,736 (60.7) 7,991 (29.3) <0.001 Cardiovascular [i.e. pulmonary embolus, DVT, acute MI] 3,642 (25.3) 1,985 (7.3) <0.001 Pulmonary [i.e. pleural effusion, ARDS, pulmonary collapse] 2,871 (20.0) 1,732 (6.4) <0.001 Gastrointestinal [i.e. pancreatic necrosis, ileus, pancreatic pseudocyst] 3,935 (27.4) 4,847 (17.8) <0.001 Renal and Endocrine [i.e. postprocedural renal failure, hypoglycemia] 174 (1.2) 95 (0.3) <0.001 Neurologic [i.e. postprocedural brain hemorrhage, anoxic brain damage] 124 (0.9) 25 (<0.1) <0.001 Infectious [i.e. SIRS, severe sepsis, infection following procedure] 3,443 (23.9) 1,169 (4.3) <0.001 SIRS (systemic inflammatory response syndrome) 274 (1.9) 453 (1.7) 0.426 Other infectious [i.e. sepsis, severe sepsis] 3,169 (22.0) 726 (2.7) <0.001 Mortality 667 (4.6) 25 (<0.1) <0.001 Abbreviations: ERCP, Endoscopic Retrograde Cholangiopancreatography, DVT, Deep Vein Thrombosis, MI, myocardial infarction, ARDS, Acute Respiratory Distress Syndrome, SIRS, Systemic Inflammatory Response Syndrome. Table 3. Multivariable Analysis for Predictors of Composite Complications in Patients with post-ERCP pancreatitis Predictors Adjusted Odds Ratio 95% CI Adjusted P-value Frailty status Non-frail Frail Reference 2.94 2.64-3.28 <0.001 Age, per 5-year increase 0.98 0.97-1.00 0.131 Race White Black Hispanic Asian or Pacific Islander Reference 1.15 0.79 0.81 0.96-1.37 0.69-0.92 0.63-1.04 0.119 0.002 0.097 Sex Male Female Reference 0.84 0.76-0.93 0.001 Median household income 0-25th percentile 26-50th percentile 51-75th percentile 76-100th percentile Reference 0.96 1.08 1.07 0.84-1.11 0.94-1.24 0.92-1.24 0.604 0.274 0.373 Insurance Medicare Medicaid Private Self-pay No charge Reference 1.03 1.07 0.88 0.62 0.85-1.25 0.92-1.25 0.67-1.15 0.27-1.42 0.744 0.367 0.339 0.257 Charlson comorbidity index 0 1 2 ≥ 3 Reference 1.34 1.95 2.92 1.17-1.53 1.67-2.29 2.53-3.37 <0.001 <0.001 <0.001 Abbreviations: ERCP, Endoscopic Retrograde Cholangiopancreatography. Additional Declarations No competing interests reported. Supplementary Files FrailtyandPEPAppendix.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-6291035\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":439138759,\"identity\":\"43478d32-28a6-461d-9e38-08e894d15d6b\",\"order_by\":0,\"name\":\"Camilo J Acosta\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"University of Miami Miller School of Medicine\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Camilo\",\"middleName\":\"J\",\"lastName\":\"Acosta\",\"suffix\":\"\"},{\"id\":439138760,\"identity\":\"4629e545-cb27-4b83-bc28-c3881927f7a0\",\"order_by\":1,\"name\":\"Sunil Amin\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"University of Miami Miller School of Medicine\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Sunil\",\"middleName\":\"\",\"lastName\":\"Amin\",\"suffix\":\"\"},{\"id\":439138761,\"identity\":\"a40799d0-b39e-401b-bccc-163a5d1652d4\",\"order_by\":2,\"name\":\"Jodie A. Barkin\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+klEQVRIiWNgGAWjYBACxgYeIHlAgoEfSEmAETOQxUOMFskGYrVAZA8wMBgcAKtHEsQFmNvPHvxcccYiz/ja4YM3GHMs5HXbGRgfvG3D47CevGTJMzckis1upyVbMG6TMNx2mIHZcC4+LQ05BpINHyQSt93OMZMAamEEamGT5sWnpf+N8U+Qls2z87+BtNgDtbD/xqtlRo6ZZMMNicQN0jlsIC2JIFuY8Wt5l2bZcEYiccbtNGOLxG0SydsOMzZLzjmHW4thf+7hmw3H6hL7Zyc/vPFxW53ttvOHD354U4ZHSwMyLwFicwOmOiQgj1d2FIyCUTAKRgEIAAAOR1QAiI7L0gAAAABJRU5ErkJggg==\",\"orcid\":\"\",\"institution\":\"University of Miami Miller School of Medicine\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Jodie\",\"middleName\":\"A.\",\"lastName\":\"Barkin\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2025-03-24 02:53:15\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-6291035/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-6291035/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":80812238,\"identity\":\"d5339dd4-7016-49b7-a9b9-67b6fc3bd36e\",\"added_by\":\"auto\",\"created_at\":\"2025-04-17 10:36:48\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":68029,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eStudy design and patient selection algorithm. ERCP indicates endoscopic retrograde cholangiopancreatography; HCUP, Healthcare Cost and Utilization Project; ICD-10-CM, International Classification of Diseases, Tenth Revision, Clinical Modification; ICD-10-PCS, International Classification of Diseases, Tenth Revision, Procedure Coding System.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6291035/v1/edb792350e96452be1487e42.png\"},{\"id\":80812239,\"identity\":\"5cce0ffa-9f24-40fa-aca8-3874d2e40a9b\",\"added_by\":\"auto\",\"created_at\":\"2025-04-17 10:36:48\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":58401,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eMarginal Standardization Analysis between Age and Frailty.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"2.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6291035/v1/a9c6b94bf3034d9f2dabab0c.png\"},{\"id\":81731909,\"identity\":\"5991fc50-8429-434a-892f-506dc523d936\",\"added_by\":\"auto\",\"created_at\":\"2025-04-30 19:23:29\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":1040210,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6291035/v1/9a57efd7-ec05-46a9-876a-d1b8fda34e49.pdf\"},{\"id\":80813870,\"identity\":\"3050b9a1-9dfc-430a-a13b-c1ff756602bf\",\"added_by\":\"auto\",\"created_at\":\"2025-04-17 10:44:48\",\"extension\":\"docx\",\"order_by\":1,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":25034,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"FrailtyandPEPAppendix.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6291035/v1/23037832f2e809d72eac0ed0.docx\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Frailty as a Predictor of Outcomes in Patients with Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis \",\"fulltext\":[{\"header\":\"Core tip\",\"content\":\"\\u003cp\\u003eThis is a retrospective cohort study to investigate the association between frailty and outcomes in patients with post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). Of 41,615 patients represented in the data, 60.7% of frail patients suffered composite complications related to PEP compared to 29.3% of non-frail patients including cardiovascular, pulmonary, gastrointestinal, renal and endocrine, neurologic, and infectious complications. Frail patients also had higher all-cause mortality rates during inpatient admission, increased length of stay, and total hospitalization charges. Frailty assessment can thus be used to further guide clinical decision-making as a risk stratification tool when determining to pursue preventive methods for PEP.\\u0026nbsp;\\u003c/p\\u003e\"},{\"header\":\"INTRODUCTION\",\"content\":\"\\u003cp\\u003eEndoscopic retrograde cholangiopancreatography (ERCP) carries a post-ERCP pancreatitis (PEP) rate of 2\\u0026ndash;10%, which can be as high as 30\\u0026ndash;50% in high-risk cases.\\u003csup\\u003e[\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]\\u003c/sup\\u003e It remains as the most common and most severe complication related to ERCP.\\u003csup\\u003e[\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e]\\u003c/sup\\u003e In up to 5% of PEP cases, there can be potential for life-threatening complications, including multi-organ failure, peripancreatic fluid collections, and death with a mortality rate that can reach 1%.\\u003csup\\u003e[\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e]\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003eThere are various measures employed to prevent PEP as a complication including pharmacologic and endoscopic methods with varying success. These include the use of peri-procedural intravenous fluids, rectal indomethacin, and pancreatic stent placement. Deciding when to use these preventive techniques becomes an important question, in order to provide the most appropriate peri-procedural management and consequently minimize likelihood of PEP.\\u003csup\\u003e[\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003eIn this regard, studies have shown various patient-related factors that increase risk of PEP to be suspected sphincter of Oddi dysfunction (SOD), female gender, previous pancreatitis, previous PEP, non-dilated common bile duct, normal bilirubin, younger age, and end stage renal disease.\\u003csup\\u003e[\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e]\\u003c/sup\\u003e Procedure-related risk factors include overmanipulating the papilla, difficult cannulation, and the degree of pancreatic duct (PD) manipulation.\\u003csup\\u003e[\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e]\\u003c/sup\\u003e One predictor that remains understudied in patients with PEP is frailty status.\\u003c/p\\u003e \\u003cp\\u003eFrailty is defined as a clinical syndrome characterized by an increased state of vulnerability due a decline in function across several organ systems, that is associated with an increased risk of poor outcomes in individuals exposed to an apparently innocuous stressor.\\u003csup\\u003e[\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]\\u003c/sup\\u003e Literature on this topic has grown considerably over the last 10\\u0026ndash;15 years that has demonstrated the utility of frailty status as a strong predictor of adverse events and complications related to various procedures including pancreatoduodenectomy or pancreatic resection, kidney transplant, percutaneous coronary intervention, and colectomy.\\u003csup\\u003e[\\u003cspan additionalcitationids=\\\"CR12 CR13 CR14 CR15\\\" citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e]\\u003c/sup\\u003e There is only one prior study that has evaluated the impact of frailty on outcomes after ERCP, however. By using the Johns Hopkins\\u0026rsquo;s adjusted clinical groups (ACG) frailty indicator system, the authors found frailty status to be associated with worse outcomes such as heightened mortality, prolonged hospital stays, and increased healthcare costs in nonagenarian patients after ERCP.\\u003csup\\u003e[\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e]\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003eDespite the development and validation of various frailty measurement tools, the majority are too complex for use in the acute care setting or require some form of manual evaluation process that becomes a deterrent for use in hospitalized patients. The Hospital Frailty Risk Score (HFRS) is a predictive tool based on ICD-10 codes that was developed in the United Kingdom and validated against two prominent clinical measures of frailty: the Fried Phenotype and Rockwood Frailty Index.\\u003csup\\u003e[\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e]\\u003c/sup\\u003e As defined by the HFRS, frailty has been demonstrated to be a predictor of poor clinical outcomes for patients with inflammatory bowel disease, heart failure, acute myocardial infarction, and pneumonia as well as those undergoing total hip and knee arthroplasty, percutaneous coronary intervention, spinal surgery, and cardiac arrest in separate investigations.\\u003csup\\u003e[\\u003cspan additionalcitationids=\\\"CR20 CR21 CR22 CR23 CR24\\\" citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e]\\u003c/sup\\u003e We have also published two separate studies demonstrating that positive frailty status, as defined by the HFRS, is associated with increased peri-procedural complication risk in patients with gastrointestinal bleeding who undergo endoscopy and with worse clinical outcomes in patients admitted with acute pancreatitis.\\u003csup\\u003e[\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e]\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003eThe aim of our study was to use the HFRS to determine the association between frailty status and risk of adverse events in hospitalized patients with post-ERCP pancreatitis. We hypothesized frailty would be a strong indicator of adverse events and all-cause mortality as well as secondary outcomes (length of stay and hospitalization charges) among this patient population.\\u003c/p\\u003e\"},{\"header\":\"MATERIALS AND METHODS\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eData Source\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eData was obtained from the National Inpatient Sample (NIS), which is the largest publicly available all-payer inpatient database available in the United States and forms part of the Healthcare Cost and Utilization Project (HCUP). This database represents approximately 20% of the stratified sample of U.S. nonfederal acute care hospitals. The NIS contains both patient- and hospital-level information (including demographic variables, primary and secondary diagnoses, discharge disposition, primary and secondary procedures, etc.), with safeguards to protect the privacy of patients, physicians, and hospitals. As such, de-identified data was used in this study that did not require institutional review board approval. \\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eStudy population\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAppended data were used from the HCUP NIS for the years 2016-2017.\\u003csup\\u003e28\\u003c/sup\\u003e International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnostic codes were utilized to identify adult patients with post-ERCP pancreatitis during admission. This was based on a methodology that was used and validated previously.\\u003csup\\u003e[29-32]\\u003c/sup\\u003e This method includes differentiating between acute pancreatitis at admission from PEP. In brief, patients who underwent ERCP after the day of admission and had a diagnosis of acute pancreatitis that was not a primary diagnosis (therefore patients who were not admitted with acute pancreatitis due to a different etiology) were classified as patients with PEP. ICD-9 codes used in previous studies were mapped to corresponding ICD-10 codes (Appendix). Patients were excluded if they were younger than 18 years of age or if there was missing date on age or gender. \\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eStudy variables\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eDemographic information including age, sex, race, median annual income in patient\\u0026rsquo;s zip code, and hospital region were provided within the NIS for each hospitalization, along with length of stay and total hospitalization charges per admission. Comorbid conditions were recorded if they were listed among the discharge diagnoses and the Charlson Comorbidity Index (CCI) was used to assess the burden of comorbid disease, utilizing a validated ICD-10 coding scheme that builds on Deyo\\u0026rsquo;s adaptation and Quan\\u0026rsquo;s algorithm of the CCI for use with contemporary U.S. databases.\\u003csup\\u003e[33]\\u003c/sup\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eDefinition of frailty\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eFrailty was defined using a previously validated algorithm of ICD-10 codes, known as the Hospital Frailty Risk Score (HFRS). This score was developed by Gilbert et al. via a cluster analysis of British adults 75 years and older, who had diagnoses in electronic medical records that were associated with frailty and high resource utilization.\\u003csup\\u003e[18]\\u003c/sup\\u003e The HFRS was then derived from an aggregate of 109 ICD-10 codes that were over-represented in this cluster with each code awarded specific values proportional to how strongly they predicted frailty. These codes are inclusive primarily of neurologic (i.e., dementia, intracranial injury, abnormal gait), endocrine (i.e., vitamin deficiencies, thyrotoxicosis), renal (i.e., acute and chronic renal failure), genitourinary (i.e., urinary incontinence or retention, urinary tract infection), soft tissue/skin (i.e. gangrene, ulcerations, cellulitis), and musculoskeletal (i.e. fracture, falls) conditions. In a national validation cohort of more than a million patients, a HFRS \\u0026ge; 5 was found to indicate intermediate (or greater) frailty and was associated with increased 30-day hospital readmission and increased 30-day mortality. Therefore, a cutoff of HFRS \\u0026ge; 5 was established to classify patients as frail while patients with HFRS \\u0026lt; 5 were classified as non-frail. Using this scoring scheme, the HFRS was thereafter externally validated in a Swiss tertiary care hospital and in elderly patients in Canada, where it was found to independently predict mortality, length of stay, and 30-day readmission.\\u003csup\\u003e[34,35]\\u003c/sup\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eOutcomes\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe primary outcomes were pancreatitis-related and peri-procedural adverse events including all-cause mortality. A patient was recorded as having a pancreatitis-related or peri-procedural adverse event if any of a number of pre-defined ICD-10 codes for the aforementioned events occurred within the same admission (Appendix). These codes were based off of well-known complications of acute pancreatitis as well as established peri-procedural and postoperative adverse events.\\u003csup\\u003e[36-42]\\u003c/sup\\u003e Codes that were used for inclusion criteria to identify patients with PEP, and codes that form part of the HFRS were excluded as markers for complications. \\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eStatistical analysis\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAll statistical analyses were performed using STATA v16.1 (College Station, Texas).\\u003csup\\u003e[43]\\u003c/sup\\u003e Sample sizes were estimated by applying the discharge weight (DISCWT) and using Stata\\u0026apos;s survey estimation command to adjust for the complex sampling design of the NIS. Demographic variables between frail and non-frail patients were compared using t-tests for continuous variables and chi-square tests for categorical variables. Univariate logistic regression analysis was used to calculate unadjusted odds ratios (ORs) for the primary outcomes. Multivariate logistic regression models were then used to adjust for clinically relevant confounders. Results were reported as adjusted odds ratios (aORs) with 95% confidence intervals (CIs) and a two-sided p-value \\u0026lt;0.05 indicated statistical significance. Finally, marginal standardization analysis was performed to assess for possible interaction between age and frailty status. As part of this analysis, age was stratified into 10-year increments.\\u0026nbsp;\\u003c/p\\u003e\"},{\"header\":\"RESULTS\",\"content\":\"\\u003cp\\u003eA total of 8,364 (weighted n = 41,615) adult patients were discharged with a diagnosis of PEP in the NIS from 2016-2017 (Figure 1). \\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eThe proportion of frail vs non-frail patients was rightly distributed in a 1:2 ratio, with 34.6% (weighted n = 14,382) characterized as frail and 65.4% (weighted n = 27,233) as non-frail (Table 1). Frail patients with PEP had a significantly higher mean age than non-frail patients (68.5 years vs 55.6 years, P \\u0026lt; 0.001). They were also found to have a significantly higher burden of comorbidities with a CCI \\u0026ge; 3 (38.7% vs 13.9%, P \\u0026lt; 0.001) compared to those who were non-frail. Length of stay for frail patients was twice as long on average compared to non-frail patients (11.6 vs 5.8 days, P \\u0026lt; 0.001), and total hospitalization charges incurred during admission for frail patients were approximately double the amount compared to their non-frail counterparts ($140,855 vs $73,539, P \\u0026lt; 0.001). \\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eComposite peri-procedural adverse events and complications related to pancreatitis including all-cause inpatient mortality were found to be significantly more common among frail patients discharged with a diagnosis of PEP (60.7% vs 29.3%, P \\u0026lt; 0.001) compared to non-frail patients (Table 2). By organ system, frail patients had more gastrointestinal (27.4% vs 17.8%, P \\u0026lt; 0.001), cardiovascular (25.3% vs 7.3%, P \\u0026lt; 0.001), infectious (23.9% vs 4.3%, P \\u0026lt; 0.001), pulmonary (20.0% vs 6.4%, P \\u0026lt; 0.001), renal and endocrine (1.2% vs 0.3%, P \\u0026lt; 0.001), and neurologic (0.9% vs \\u0026lt; 0.1%, P \\u0026lt; 0.001) adverse events compared to those who were fit. With regards to all-cause in-hospital mortality, a total of 1.7% of patients in the study population died during hospitalization, accounting for an estimated 692 deaths nationwide between 2016-2017. Notably, frail patients had higher all-cause mortality rates during inpatient admission compared to non-frail patients (4.6% vs \\u0026lt; 0.1%, P \\u0026lt; 0.001). \\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eDespite adjusting for potential confounders, positive frailty status was associated with 2.94 times increased odds of having composite adverse events (aOR 2.94, 95% CI: 2.64-3.28, P \\u0026lt; 0.001) (Table 3). Other predictors of complications were elevated burden of comorbidities with CCI \\u0026ge; 3 (aOR 2.92, 95% CI: 2.53-3.37), female gender (aOR 0.84, 95% CI: 0.76-0.93), and Hispanic race (aOR 0.79, 95% CI: 0.69-0.92). Complete results of the multivariable logistic regression analysis performed are shown in Table 3. \\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eOn marginal standardization analysis between age and frailty status, there was a consistent rate of adverse events for frail patients irrespective of increasing age. Specifically, there was a 20-23% difference in adverse event rate between frail and non-frail patients by 10-year increments from 40 years to 90 years of age (Figure 2).\\u0026nbsp;\\u003c/p\\u003e\"},{\"header\":\"DISCUSSION\",\"content\":\"\\u003cp\\u003eWith the population of elderly patients rising globally, the prevalence of frailty is expected to continue to increase over time.\\u003csup\\u003e[\\u003cspan citationid=\\\"CR44\\\" class=\\\"CitationRef\\\"\\u003e44\\u003c/span\\u003e]\\u003c/sup\\u003e Frailty status has consequently become an increasingly relevant topic around patient risk and adverse events.\\u003csup\\u003e[\\u003cspan citationid=\\\"CR45\\\" class=\\\"CitationRef\\\"\\u003e45\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR46\\\" class=\\\"CitationRef\\\"\\u003e46\\u003c/span\\u003e]\\u003c/sup\\u003e One area that remains understudied with regards to the impact of frailty on clinical outcomes is post-ERCP pancreatitis. Therefore, we sought to investigate in the present study the association between frailty status and complications related to PEP among hospitalized adults.\\u003c/p\\u003e \\u003cp\\u003eOur analysis is representative of over 41,000 patients nationwide, and indicates that positive frailty status with HFRS\\u0026thinsp;\\u0026ge;\\u0026thinsp;5 in patients with PEP is associated with increased risk of composite complications (60.7% vs 29.3%, P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001) compared to non-frail patients across various organ systems including gastrointestinal (27.4% vs 17.8%, P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), cardiovascular (25.3% vs 7.3%, P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), infectious (23.9% vs 4.3%, P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), pulmonary (20.0% vs 6.4%, P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), renal and endocrine (1.2% vs 0.3%, P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), and neurologic (0.9% vs\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.1%, P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001) adverse events. Moreover, in terms of infectious complications, frail patients have a higher proportion of sepsis and severe sepsis events than non-frail patients (22.0% vs 2.7%, P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001). Mortality during admission was significantly higher among frail patients, with nearly a 25-fold increased proportion of patients suffering from in-hospital death. Finally, length of stay was significantly longer for frail patients with close to an additional six days of inpatient admission required, and total hospitalization charges during inpatient stay for frail patients were significantly higher, totaling over \\u003cspan\\u003e$\\u003c/span\\u003e140,000 compared to under \\u003cspan\\u003e$\\u003c/span\\u003e74,000 for non-frail patients.\\u003c/p\\u003e \\u003cp\\u003eComorbidity burden (as assessed by the Charlson Comorbidity Index) was positively associated with adverse event risk, which was an expected finding, in addition to female gender and Hispanic race. Accordingly, we ensured to correct for these confounders in our multivariable analysis which showed frailty is affiliated with increased complication risk independent of CCI, gender, or race. Increasing age was not found to be a significant predictor of composite complications, which is in line with prior studies that have actually demonstrated younger age to be an independent risk factor for PEP.\\u003csup\\u003e[\\u003cspan additionalcitationids=\\\"CR4 CR5 CR6\\\" citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR47\\\" class=\\\"CitationRef\\\"\\u003e47\\u003c/span\\u003e]\\u003c/sup\\u003e Notwithstanding, to rule out any possible interaction between age and frailty status, we performed marginal standardization analysis. This analysis showed frailty was associated with a consistent rate in adverse events in relation to age, indicating that age alone cannot explain our findings (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eThese results suggest an important benefit of frailty assessment as a risk stratification tool in patients undergoing ERCP who are at risk for PEP and PEP-related adverse complications. In this light, our results affirm the value of frailty evaluation as an independent tool to help guide medical decision-making when determining whether to employ preventive and prophylactic methods for PEP.\\u003c/p\\u003e \\u003cp\\u003eOur findings are consistent with the only similar investigation reported by Basida et al. who demonstrated that frail nonagenarians undergoing ERCP had heightened mortality, prolonged hospital stays, and increased healthcare costs compared to non-frail counterparts.\\u003csup\\u003e[\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e]\\u003c/sup\\u003e In their retrospective analysis, patients between 90 and 99 years old were categorized as frail or non-frail according to the Johns Hopkins\\u0026rsquo;s adjusted clinical groups (ACG) frailty indicator system, which is similar to the HFRS in the sense that it relies on diagnosis codes.\\u003c/p\\u003e \\u003cp\\u003eThe present study has several limitations; however, many of these are due to the inherent nature of population-based datasets. We have attempted to overcome these issues as best as possible through rigorous statistical methodology. First, the NIS data lack the clinical detail available in other study designs and in general clinical practice (vital signs, lab values, pharmacotherapy). Such data are useful for denoting the severity of underlying disease and for confirming the presence of comorbid conditions and adverse events. In this regard, we were able to apply a validated general prognostic scale, the Charlson Comorbidity Index, to effectively assess the burden of comorbid illness. Second, the use of ICD-10 codes to establish diagnoses, procedures, and adverse events can result in the misclassification or underreporting of the aforementioned. Nevertheless, the reliability of administrative codes in identifying patients with PEP has been shown to be high and validated in previous studies.\\u003csup\\u003e[\\u003cspan additionalcitationids=\\\"CR30 CR31\\\" citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e]\\u003c/sup\\u003e Third, the retrospective nature of this study only allows for associational rather than causational conclusions, but the use of data from a nationwide population-based sample still provides strong evidence for generalizing these observations to national clinical practice in the United States. Finally, the actual cause of death is not captured in the NIS, so we reported total all-cause inpatient mortality, which is in agreement with other investigations examining mortality in patients with PEP.\\u003csup\\u003e[\\u003cspan additionalcitationids=\\\"CR30 CR31\\\" citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e]\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003eIn conclusion, these data suggest that frailty status is associated with increased adverse events and complications including all-cause mortality during hospitalization for patients with PEP. The use of frailty evaluation can thus further guide clinical decision-making as a risk stratification tool when balancing the utility of preventive and prophylactic methods for PEP, including rectal indomethacin, intravenous fluids, and/or pancreatic stenting. These interventions have proven benefits particularly in high-risk patients, yet their widespread use in the United States and North America remains suboptimal for a variety of reasons.\\u003csup\\u003e[\\u003cspan citationid=\\\"CR48\\\" class=\\\"CitationRef\\\"\\u003e48\\u003c/span\\u003e]\\u003c/sup\\u003e Frailty assessment can therefore be a key proactive resource of substantial importance in guiding early interventions for patients at risk of worse outcomes related to PEP. While the HFRS is a robust frailty measure, calculating this score involves a large number of administrative codes, and it is not incorporated into current hospital-based digital platforms. Future efforts should hence be focused on translating the HFRS into a more simplistic, readily available tool and the development of a rapid clinical calculator to aid in the decision-making process of management of patients with or at risk for PEP due to frailty status to minimize the impact and incidence of PEP in this population, and reduce PEP-associated morbidity and mortality.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003ch2\\u003eAuthor Contribution\\u003c/h2\\u003e\\n\\u003cp\\u003eCamilo J. Acosta study concept and design, acquisition of data, statistical analysis and interpretation of data; drafting and critical revision of the manuscript. Sunil Amin study concept and design, acquisition of data, statistical analysis and interpretation of data; critical revision of the manuscript for important intellectual concept.Jodie A. Barkin study concept and design, statistical analysis and interpretation of data, critical revision of the manuscript for important intellectual concept.\\u003c/p\\u003e\\n\\u003ch2\\u003eACKNOWLEDGEMENTS\\u003c/h2\\u003e\\n\\u003cp\\u003eNone of the listed authors have any conflicts of interest to disclose.\\u003c/p\\u003e\\n\\u003cp\\u003eFinancial support: None.\\u003c/p\\u003e\\n\\u003cp\\u003ePotential competing interests: None.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n \\u003cli\\u003eCahyadi O, Tehami N, de-Madaria E, Siau K. Post-ERCP Pancreatitis: Prevention, Diagnosis and Management.\\u0026nbsp;\\u003cem\\u003eMedicina (Kaunas)\\u003c/em\\u003e. 2022;58(9):1261. Published 2022 Sep 12. doi:10.3390/medicina58091261\\u003c/li\\u003e\\n \\u003cli\\u003eArata S, Takada T, Hirata K, et al. Post-ERCP pancreatitis.\\u0026nbsp;\\u003cem\\u003eJ Hepatobiliary Pancreat Sci\\u003c/em\\u003e. 2010;17(1):70-78. doi:10.1007/s00534-009-0220-5\\u003c/li\\u003e\\n \\u003cli\\u003eBorrelli de Andreis F, Mascagni P, Schepis T, et al. Prevention of post-ERCP pancreatitis: current strategies and novel perspectives.\\u0026nbsp;\\u003cem\\u003eTherap Adv Gastroenterol\\u003c/em\\u003e. 2023;16:17562848231155984. Published 2023 Mar 6. doi:10.1177/17562848231155984\\u003c/li\\u003e\\n \\u003cli\\u003eChen JJ, Wang XM, Liu XQ, et al. Risk factors for post-ERCP pancreatitis: a systematic review of clinical trials with a large sample size in the past 10 years.\\u0026nbsp;\\u003cem\\u003eEur J Med Res\\u003c/em\\u003e. 2014;19(1):26. Published 2014 May 15. doi:10.1186/2047-783X-19-26\\u003c/li\\u003e\\n \\u003cli\\u003eDing X, Zhang F, Wang Y. Risk factors for post-ERCP pancreatitis: A systematic review and meta-analysis.\\u0026nbsp;\\u003cem\\u003eSurgeon\\u003c/em\\u003e. 2015;13(4):218-229. doi:10.1016/j.surge.2014.11.005\\u003c/li\\u003e\\n \\u003cli\\u003eEl Nakeeb A, El Hanafy E, Salah T, et al. Post-endoscopic retrograde cholangiopancreatography pancreatitis: Risk factors and predictors of severity.\\u0026nbsp;\\u003cem\\u003eWorld J Gastrointest Endosc\\u003c/em\\u003e. 2016;8(19):709-715. doi:10.4253/wjge.v8.i19.709\\u003c/li\\u003e\\n \\u003cli\\u003eDumonceau JM, Kapral C, Aabakken L, et al. ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline.\\u0026nbsp;\\u003cem\\u003eEndoscopy\\u003c/em\\u003e. 2020;52(2):127-149. doi:10.1055/a-1075-4080\\u003c/li\\u003e\\n \\u003cli\\u003eLee YS, Cho CM, Cho KB, et al. Difficult Biliary Cannulation from the Perspective of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis: Identifying the Optimal Timing for the Rescue Cannulation Technique.\\u0026nbsp;\\u003cem\\u003eGut Liver\\u003c/em\\u003e. 2021;15(3):459-465. doi:10.5009/gnl19304\\u003c/li\\u003e\\n \\u003cli\\u003eNakai Y, Isayama H, Sasahira N, et al. Risk factors for post-ERCP pancreatitis in wire-guided cannulation for therapeutic biliary ERCP.\\u0026nbsp;\\u003cem\\u003eGastrointest Endosc\\u003c/em\\u003e. 2015;81(1):119-126. doi:10.1016/j.gie.2014.06.005\\u003c/li\\u003e\\n \\u003cli\\u003eXue QL. The frailty syndrome: definition and natural history.\\u0026nbsp;Clin Geriatr Med. 2011;27(1):1-15. doi:10.1016/j.cger.2010.08.009\\u003c/li\\u003e\\n \\u003cli\\u003eRostoft S, van Leeuwen B. Frailty assessment tools and geriatric assessment in older patients with hepatobiliary and pancreatic malignancies. European Journal of Surgical Oncology. 2021;47(3, Part A):514-518.\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eAl Abbas AI, Borrebach JD, Pitt HA, et al. Development of a Novel Pancreatoduodenectomy-Specific Risk Calculator: an Analysis of 10,000 Patients [published online ahead of print, 2020 Jul 15].\\u0026nbsp;J Gastrointest Surg. 2020;10.1007/s11605-020-04725-0.\\u003c/li\\u003e\\n \\u003cli\\u003eAugustin T, Burstein MD, Schneider EB, et al. Frailty predicts risk of life-threatening complications and mortality after pancreatic resections. Surgery. 2016;160(4):987-996.\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eCheng XS, Lentine KL, Koraishy FM, et al. Implications of Frailty for Peritransplant Outcomes in Kidney Transplant Recipients. Curr Transplant Rep. 2019;6(1):16-25. \\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eKim DH, Kim CA, Placide S, et al. Preoperative Frailty Assessment and Outcomes at 6 Months or Later in Older Adults Undergoing Cardiac Surgical Procedures: A Systematic Review. Annals of Internal Medicine. 2016;165(9):650-660.\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eMosquera C, Spaniolas K, Fitzgerald TL. Impact of frailty on surgical outcomes: The right patient for the right procedure. Surgery. 2016;160(2):272-280.\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eBasida SD, Dahiya DS, Yousaf MN, et al. Impact of frailty on endoscopic retrograde cholangiopancreatography outcomes in nonagenarians: A United States national experience.\\u0026nbsp;World J Gastrointest Endosc. 2024;16(3):148-156. doi:10.4253/wjge.v16.i3.148\\u003c/li\\u003e\\n \\u003cli\\u003eGilbert T, Neuburger J, Kraindler J, et al. Development and validation of a Hospital Frailty Risk Score focusing on older people in acute care settings using electronic hospital records: an observational study. Lancet. 2018;391(10132):1775-1782.\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eKochar B, Cai W, Cagan A, Ananthakrishnan AN. Frailty is independently associated with mortality in 11\\u0026nbsp;001 patients with inflammatory bowel diseases. Alimentary Pharmacology \\u0026amp; Therapeutics. 2020;52(2):311-318.\\u003c/li\\u003e\\n \\u003cli\\u003eKwok CS, Zieroth S, Van Spall HGC, et al. The Hospital Frailty Risk Score and its association with in-hospital mortality, cost, length of stay and discharge location in patients with heart failure short running title: Frailty and outcomes in heart failure. International Journal of Cardiology. 2020;300:184-190. \\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eKundi H, Wadhera RK, Strom JB, et al. Association of Frailty With 30-Day Outcomes for Acute Myocardial Infarction, Heart Failure, and Pneumonia Among Elderly Adults. JAMA Cardiol. 2019;4(11):1084-1091. \\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eMeyer M, Parik L, Lei\\u0026szlig; F, Renkawitz T, et al. Hospital Frailty Risk Score Predicts Adverse Events in Primary Total Hip and Knee Arthroplasty. The Journal of Arthroplasty. 2020;35(12):3498-3504.e3. \\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eKwok CS, Achenbach S, Curzen N, et al. Relation of frailty to outcomes in percutaneous coronary intervention. Cardiovascular Revascularization Medicine. Published online November 15, 2019.\\u003c/li\\u003e\\n \\u003cli\\u003eHannah TC, Neifert SN, Caridi JM, et al. Utility of the Hospital Frailty Risk Score for Predicting Adverse Outcomes in Degenerative Spine Surgery Cohorts. Neurosurgery. 2020;(nyaa248).\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eSmith RJ, Reid DA, Santamaria JD. Frailty is associated with reduced prospect of discharge home after in-hospital cardiac arrest. Internal Medicine Journal. 2019;49(8):978-985.\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eAcosta CJ, Goldberg D, Amin S. Evaluating the impact of frailty on periprocedural adverse events and mortality among patients with GI bleeding. Gastrointestinal Endoscopy. Published online March 19, 2021.\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eAcosta CJ, Barkin JA, Amin S. Frailty Status as a Novel Risk Stratification Tool in Patients with Acute Pancreatitis.\\u0026nbsp;\\u003cem\\u003eJ Frailty Aging\\u003c/em\\u003e. 2022;11(4):370-377. doi:10.14283/jfa.2022.58\\u003c/li\\u003e\\n \\u003cli\\u003e[dataset] HCUP National Inpatient Sample (NIS) [dataset]. Healthcare Cost and Utilization Project (HCUP). 2016-2017. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/nisoverview.jsp\\u003c/li\\u003e\\n \\u003cli\\u003eYadav D, O\\u0026apos;Connell M, Papachristou GI. Natural history following the first attack of acute pancreatitis.\\u0026nbsp;\\u003cem\\u003eAm J Gastroenterol\\u003c/em\\u003e. 2012;107(7):1096-1103. doi:10.1038/ajg.2012.126\\u003c/li\\u003e\\n \\u003cli\\u003eInamdar S, Berzin TM, Sejpal DV, et al. Pregnancy is a Risk Factor for Pancreatitis After Endoscopic Retrograde Cholangiopancreatography in a National Cohort Study.\\u0026nbsp;Clin Gastroenterol Hepatol. 2016;14(1):107-114. doi:10.1016/j.cgh.2015.04.175\\u003c/li\\u003e\\n \\u003cli\\u003eSawas T, Bazerbachi F, Haffar S, et al. End-stage renal disease is associated with increased post endoscopic retrograde cholangiopancreatography adverse events in hospitalized patients.\\u0026nbsp;World J Gastroenterol. 2018;24(41):4691-4697. doi:10.3748/wjg.v24.i41.4691\\u003c/li\\u003e\\n \\u003cli\\u003eDesai R, Patel U, Doshi S, et al. A Nationwide Assessment of the \\u0026quot;July Effect\\u0026quot; and Predictors of Post-Endoscopic Retrograde Cholangiopancreatography Sepsis at Urban Teaching Hospitals in the United States.\\u0026nbsp;\\u003cem\\u003eClin Endosc\\u003c/em\\u003e. 2019;52(5):486-496. doi:10.5946/ce.2018.190\\u003c/li\\u003e\\n \\u003cli\\u003eGlasheen WP, Cordier T, Gumpina R, et al. Charlson Comorbidity Index: ICD-9 Update and ICD-10 Translation. Am Health Drug Benefits. 2019;12(4):188-197.\\u003c/li\\u003e\\n \\u003cli\\u003eEckart A, Hauser SI, Haubitz S, et al. Validation of the hospital frailty risk score in a tertiary care hospital in Switzerland: results of a prospective, observational study. BMJ Open. 2019;9(1):e026923.\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eMcAlister F, van Walraven C. External validation of the Hospital Frailty Risk Score and comparison with the Hospital-patient One-year Mortality Risk Score to predict outcomes in elderly hospitalised patients: a retrospective cohort study. BMJ Qual Saf. 2019;28(4):284.\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eNegr\\u0026oacute;n ME, Rezaie A, Barkema HW, et al. Ulcerative Colitis Patients With Clostridium difficile are at Increased Risk of Death, Colectomy, and Postoperative Complications: A Population-Based Inception Cohort Study.\\u0026nbsp;Am J Gastroenterol. 2016;111(5):691-704.\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eKhan NA, Quan H, Bugar JM, Lemaire JB, Brant R, Ghali WA. Association of postoperative complications with hospital costs and length of stay in a tertiary care center. J Gen Intern Med. 2006;21(2):177-180.\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eThavamani A, Umapathi KK, Sferra TJ, et al. Undernutrition and Obesity Are Associated with Adverse Clinical Outcomes in Hospitalized Children and Adolescents with Acute Pancreatitis. Nutrients. 2020;13(1):43. \\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eDevani K, Charilaou P, Radadiya D, et al. Acute pancreatitis: Trends in outcomes and the role of acute kidney injury in mortality- A propensity-matched analysis. Pancreatology. 2018;18(8):870-877. \\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eBrindise, E., Elkhatib, I. , Kuruvilla, A. \\u0026amp; Silva, R. (2019). Temporal Trends in Incidence and Outcomes of Acute Pancreatitis in Hospitalized Patients in the United States From 2002 to 2013. Pancreas, 48(2), 169\\u0026ndash;175.\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eSawas T, Storm AC, Bazerbachi F, et al. An innovative technique using a\\u0026nbsp;percutaneously placed guidewire allows for higher success rate for ERCP compared to balloon enteroscopy assistance in Roux-en-Y gastric bypass anatomy.\\u0026nbsp;Surg Endosc. 2020;34(2):806-813. doi:10.1007/s00464-019-06832-9\\u003c/li\\u003e\\n \\u003cli\\u003eLieber SR, Heller BJ, Howard CW, Sandler RS, Crockett S, Barritt AS 4th. Complications Associated With Anesthesia Services in Endoscopic Procedures Among Patients With Cirrhosis.\\u0026nbsp;Hepatology. 2020;72(6):2109-2118. doi:10.1002/hep.31224\\u003c/li\\u003e\\n \\u003cli\\u003eStataCorp. 2019.\\u0026nbsp;Stata Statistical Software: Release 16. College Station, TX: StataCorp LLC\\u003c/li\\u003e\\n \\u003cli\\u003eHoogendijk EO, Afilalo J, Ensrud KE, et al. Frailty: implications for clinical practice and public health. The Lancet. 2019;394(10206):1365-1375. \\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eRobinson TN, Walston JD, Brummel NE, et al. Frailty for Surgeons: Review of a National Institute on Aging Conference on Frailty for Specialists. J Am Coll Surg. 2015;221(6):1083-1092.\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eWalston J, Robinson TN, Zieman S, et al. Integrating Frailty Research into the Medical Specialties-Report from a U13 Conference. J Am Geriatr Soc. 2017;65(10):2134-2139.\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eLosurdo G, Iannone A, Principi M, et al. Acute pancreatitis in elderly patients: A retrospective evaluation at hospital admission. European Journal of Internal Medicine. 2016;30:88-93. \\u0026nbsp;\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eBuxbaum JL, Freeman M, Amateau SK, et al. American Society for Gastrointestinal Endoscopy guideline on post-ERCP pancreatitis prevention strategies: summary and recommendations.\\u0026nbsp;\\u003cem\\u003eGastrointest Endosc\\u003c/em\\u003e. 2023;97(2):153-162. doi:10.1016/j.gie.2022.10.005\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"},{\"header\":\"Tables\",\"content\":\"\\u003ctable style=\\\"width:535.5pt;border-collapse:collapse;border: none;\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"4\\\" style=\\\"width: 535.5pt;border: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp; \\u0026nbsp;\\u003c/span\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Arial\\\",sans-serif;'\\u003eTable 1. Demographic characteristics of adult patients with post-ERCP pancreatitis\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Arial\\\",sans-serif;'\\u003e(n = 41,615)\\u003c/span\\u003e\\u003cspan style='font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 301.5pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003eCharacteristic\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003eFrail\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e(n = 14,382)\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003eNon-frail\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e(n = 27,233)\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cstrong\\u003e\\u003cem\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003eP\\u003c/span\\u003e\\u003c/em\\u003e\\u003c/strong\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:14px;font-family: \\\"Arial\\\",sans-serif;'\\u003e value\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 301.5pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;background: rgb(237, 125, 49);padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;color:black;'\\u003eAge, mean (SD)\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(237, 125, 49);padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;color:black;'\\u003e68.5 (16.2)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(237, 125, 49);padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;color:black;'\\u003e55.6 (19.3)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(237, 125, 49);padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;color:black;'\\u003e\\u0026lt;0.001\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 301.5pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;background: rgb(237, 125, 49);padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;color:black;'\\u003eSex, no. (%)\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(237, 125, 49);padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(237, 125, 49);padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(237, 125, 49);padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;color:black;'\\u003e\\u0026lt;0.001\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 301.5pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003eMale\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e6,820 (47.4)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e10,628 (39.0)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 301.5pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003eFemale\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e7,562 (52.6)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e16,605 (61.0)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 301.5pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;background: rgb(237, 125, 49);padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;color:black;'\\u003eRace, no. (%)\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(237, 125, 49);padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(237, 125, 49);padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(237, 125, 49);padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;color:black;'\\u003e\\u0026lt;0.001\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 301.5pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003eWhite\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e9,935 (69.1)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e17,326 (63.6)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 301.5pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp 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style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003eNative American\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e93 (0.6)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e253 (0.9)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 301.5pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003eOther\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e484 (3.4)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e1,066 (3.9)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 301.5pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;background: rgb(237, 125, 49);padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;color:black;'\\u003eMedian annual income in patient\\u0026rsquo;s zip code, USD, no. (%)\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(237, 125, 49);padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(237, 125, 49);padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(237, 125, 49);padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;color:black;'\\u003e0.310\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 301.5pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003eQuartile 1 (1-42,999 in 2016 and 1-43,999 in 2017)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e4,159 (28.9)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e7,705 (28.3)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 301.5pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003eQuartile 2 (43,000-53,999 in 2016 and 44,000-55,999 in 2017)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e3,705 (25.8)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e6,972 (25.6)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 301.5pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp 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top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;color:black;'\\u003eInsurance type, no. 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style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(237, 125, 49);padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;color:black;'\\u003e\\u0026lt;0.001\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 301.5pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp 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style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003eNo charge\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e30 (0.2)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e184 (0.7)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 301.5pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003eOther\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e304 (2.1)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e788 (2.9)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 301.5pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;background: rgb(237, 125, 49);padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;color:black;'\\u003eHospital region, no. (%)\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(237, 125, 49);padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(237, 125, 49);padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(237, 125, 49);padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;color:black;'\\u003e0.586\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 301.5pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp 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style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e4.797 (17.6)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 301.5pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003eMidwest\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e1,969 (22.0)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e5,672 (20.9)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 301.5pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003eSouth\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e3,250 (36.4)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e9,892 (36.3)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 301.5pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003eWest\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e1,875 (21.0)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e6,872 (25.2)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 301.5pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;background: rgb(237, 125, 49);padding: 0in 5.4pt;height: 3.85pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;color:black;'\\u003eLength of stay in days, mean (SD)\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(237, 125, 49);padding: 0in 5.4pt;height: 3.85pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;color:black;'\\u003e11.6 (12.5)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(237, 125, 49);padding: 0in 5.4pt;height: 3.85pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;color:black;'\\u003e5.8 (4.4)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(237, 125, 49);padding: 0in 5.4pt;height: 3.85pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;color:black;'\\u003e\\u0026lt;0.001\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 301.5pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;background: rgb(237, 125, 49);padding: 0in 5.4pt;height: 3.85pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;color:black;'\\u003eTotal hospitalization charges in USD, mean (SD)\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(237, 125, 49);padding: 0in 5.4pt;height: 3.85pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;color:black;'\\u003e$140,855 ($179,991)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(237, 125, 49);padding: 0in 5.4pt;height: 3.85pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;color:black;'\\u003e$73,539 ($61,162)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(237, 125, 49);padding: 0in 5.4pt;height: 3.85pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;color:black;'\\u003e\\u0026lt;0.001\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 301.5pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;background: rgb(237, 125, 49);padding: 0in 5.4pt;height: 3.85pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;color:black;'\\u003eCharlson Comorbidity Index\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(237, 125, 49);padding: 0in 5.4pt;height: 3.85pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(237, 125, 49);padding: 0in 5.4pt;height: 3.85pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(237, 125, 49);padding: 0in 5.4pt;height: 3.85pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;color:black;'\\u003e\\u0026lt;0.001\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 301.5pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 3.85pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e0\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 3.85pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e2,821 (19.6)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 3.85pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e14,002 (51.4)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 3.85pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 301.5pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 3.85pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e1\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 3.85pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e3,358 (23.3)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 3.85pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e6,319 (23.2)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 3.85pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 301.5pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 3.85pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e2\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 3.85pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e2,646 (18.4)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 3.85pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e3,125 (11.5)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 3.85pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 301.5pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 3.85pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026ge; 3\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 3.85pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e5,557 (38.7)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 3.85pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e3,787 (13.9)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 3.85pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:14px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;'\\u003e\\u003cem\\u003e\\u003cspan style='font-family:\\\"Arial\\\",sans-serif;'\\u003eNote\\u003c/span\\u003e\\u003c/em\\u003e\\u003cspan style='font-family:\\\"Arial\\\",sans-serif;'\\u003e: Frail is defined as the presence of a HFRS (Hospital Frailty Risk Score) \\u0026ge; 5 based on validated International Classification of Diseases (ICD) codes to identify frail individuals in electronic medical records. Non-frail is defined as the presence of a HFRS \\u0026lt; 5 based on validated ICD codes to identify frailty.\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n\\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;'\\u003e\\u003cspan style='font-family:\\\"Arial\\\",sans-serif;'\\u003eAbbreviations: ERCP, Endoscopic Retrograde Cholangiopancreatography, SD, standard deviation\\u003c/span\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003ctable style=\\\"width:567.0pt;border-collapse:collapse;border: none;\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"4\\\" style=\\\"width: 567pt;border: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;\\u003c/span\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Arial\\\",sans-serif;'\\u003eTable 2. Difference in Peri-procedural Complications between Frail and Non-frail patients with post-ERCP pancreatitis\\u003c/span\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 364.5pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;background: rgb(237, 125, 49);padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;color:black;'\\u003eComplications, no (%)\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 76.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(237, 125, 49);padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;color:black;'\\u003eFrail\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;color:black;'\\u003e(n = 14,382)\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 76.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(237, 125, 49);padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;color:black;'\\u003eNon-frail\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;color:black;'\\u003e(n = 27,233)\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(237, 125, 49);padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cstrong\\u003e\\u003cem\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;color:black;'\\u003eP\\u003c/span\\u003e\\u003c/em\\u003e\\u003c/strong\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;color:black;'\\u003e value\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 364.5pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003eComposite\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 76.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e8,736 (60.7)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 76.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e7,991 (29.3)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026lt;0.001\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 364.5pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003eCardiovascular [i.e. pulmonary embolus, DVT, acute MI]\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 76.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e3,642 (25.3)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 76.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e1,985 (7.3)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026lt;0.001\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 364.5pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003ePulmonary [i.e. pleural effusion, ARDS, pulmonary collapse]\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 76.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e2,871 (20.0)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 76.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e1,732 (6.4)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026lt;0.001\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 364.5pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003eGastrointestinal [i.e. pancreatic necrosis, ileus, pancreatic pseudocyst]\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 76.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e3,935 (27.4)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 76.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e4,847 (17.8)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026lt;0.001\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 364.5pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003eRenal and Endocrine [i.e. postprocedural renal failure, hypoglycemia]\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 76.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e174 (1.2)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 76.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e95 (0.3)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026lt;0.001\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 364.5pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003eNeurologic [i.e. postprocedural brain hemorrhage, anoxic brain damage]\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 76.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e124 (0.9)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 76.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e25 (\\u0026lt;0.1)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026lt;0.001\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 364.5pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003eInfectious [i.e. SIRS, severe sepsis, infection following procedure]\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 76.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e3,443 (23.9)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 76.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e1,169 (4.3)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026lt;0.001\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 364.5pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003eSIRS (systemic inflammatory response syndrome)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 76.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e274 (1.9)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 76.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e453 (1.7)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e0.426\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 364.5pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003eOther infectious [i.e. sepsis, severe sepsis]\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 76.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e3,169 (22.0)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 76.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e726 (2.7)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026lt;0.001\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 364.5pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003eMortality\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 76.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e667 (4.6)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 76.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e25 (\\u0026lt;0.1)\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:13px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026lt;0.001\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;'\\u003e\\u003cspan style='font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n\\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;'\\u003e\\u003cspan style='font-family:\\\"Arial\\\",sans-serif;'\\u003eAbbreviations: ERCP, Endoscopic Retrograde Cholangiopancreatography, DVT, Deep Vein Thrombosis, MI, myocardial infarction, ARDS, Acute Respiratory Distress Syndrome, SIRS, Systemic Inflammatory Response Syndrome.\\u003c/span\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003ctable style=\\\"width:409.5pt;border-collapse:collapse;border:none;\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"4\\\" style=\\\"width: 409.5pt;border: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:center;'\\u003e\\u003cspan style='font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;Table 3. Multivariable Analysis for Predictors of Composite Complications in Patients with post-ERCP pancreatitis\\u003c/span\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 184.5pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;background: rgb(237, 125, 49);padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Arial\\\",sans-serif;color:black;'\\u003ePredictors\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 76.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(237, 125, 49);padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:justify;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Arial\\\",sans-serif;color:black;'\\u003eAdjusted Odds Ratio\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 76.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(237, 125, 49);padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-align:justify;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Arial\\\",sans-serif;color:black;'\\u003e95% CI\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 1in;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(237, 125, 49);padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Arial\\\",sans-serif;color:black;'\\u003eAdjusted\\u0026nbsp;\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Arial\\\",sans-serif;color:black;'\\u003eP-value\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 184.5pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Arial\\\",sans-serif;'\\u003eFrailty status\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;margin-left:16.75pt;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Arial\\\",sans-serif;'\\u003eNon-frail\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;margin-left:16.75pt;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Arial\\\",sans-serif;'\\u003eFrail\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 76.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Arial\\\",sans-serif;'\\u003eReference\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Arial\\\",sans-serif;'\\u003e2.94\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 76.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Arial\\\",sans-serif;'\\u003e2.64-3.28\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 1in;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026lt;0.001\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 184.5pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp 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style='font-size:15px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Arial\\\",sans-serif;'\\u003e0.76-0.93\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 1in;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp;0.001\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 184.5pt;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;'\\u003e\\u003cstrong\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Arial\\\",sans-serif;'\\u003eMedian household income\\u003c/span\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;margin-left:16.75pt;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Arial\\\",sans-serif;'\\u003e0-25th percentile\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;margin-left:16.75pt;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Arial\\\",sans-serif;'\\u003e26-50th percentile\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;margin-left:16.75pt;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Arial\\\",sans-serif;'\\u003e51-75th percentile\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;margin-left:16.75pt;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Arial\\\",sans-serif;'\\u003e76-100th percentile\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 76.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\\\"\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Arial\\\",sans-serif;'\\u003eReference\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;'\\u003e\\u003cspan style='font-size:15px;font-family:\\\"Arial\\\",sans-serif;'\\u003e0.96\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;'\\u003e\\u003cspan 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style='font-family:\\\"Arial\\\",sans-serif;'\\u003e\\u0026nbsp;\\u003c/span\\u003e\\u003c/p\\u003e\\n\\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;text-indent:.5in;'\\u003e\\u003cspan style='font-family:\\\"Arial\\\",sans-serif;'\\u003eAbbreviations: ERCP, Endoscopic Retrograde Cholangiopancreatography.\\u003c/span\\u003e\\u003c/p\\u003e\\n\\u003cp style='margin:0in;font-size:16px;font-family:\\\"Calibri\\\",sans-serif;'\\u003e\\u003cspan style='font-family:\\\"Segoe 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Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Frail, Pancreas, Outcomes, Post-endoscopic retrograde cholangiopancreatography pancreatitis, Frailty, Pancreatitis\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-6291035/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-6291035/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003eBACKGROUND\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe development of acute pancreatitis is the most common serious complication of endoscopic retrograde cholangiopancreatography (ERCP).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAIMS\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eWe aimed to determine the association between frailty status and outcomes in patients with post-ERCP pancreatitis (PEP).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMETHODS\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eWe performed a cohort study using merged data from the 2016 and 2017 National Inpatient Sample (NIS) database. International Classification of Diseases (ICD), Tenth Revision, Clinical Modification (ICD-10-CM) and Procedure Coding system (ICD-10-PCS) diagnostic codes were utilized to identify adult patients with PEP. Using a validated frailty definition based on ICD codes known as the Hospital Frailty Risk Score (HFRS), we then classified patients as frail versus non-frail in this selected population. Primary outcomes were pancreatitis-related and peri-procedural complications including all-cause mortality. Secondary outcomes were length of stay and total hospitalization costs. We constructed multivariable logistic regression models, adjusting for clinically pertinent confounders (i.e., age, sex, comorbidities using the Charlson Comorbidity Index) to determine the association between frailty and PEP complications.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eRESULTS\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThere were 41,615 patients represented in the data, with 34.6% (14,382) characterized as frail and 65.4% (27,233) as non-frail. 60.7% of frail patients suffered composite complications related to PEP compared to 29.3% of non-frail patients (P \\u0026lt; 0.001). Frail patients had more cardiovascular, pulmonary, gastrointestinal, renal and endocrine, neurologic, and infectious complications compared to non- frail patients. Frail patients also had higher all-cause mortality rates during inpatient admission (4.6% vs under 0.1%, P \\u0026lt; 0.001) and increased length of stay (11.6 days vs 0.8, P \\u0026lt; 0.001) as well total hospitalization charges ($140,855 vs $73,539, P \\u0026lt; 0.001). On multivariable analysis, positive frailty status was associated with 2.94 times increased odds of having composite complications.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCONCLUSION\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eIn hospitalized patients with post-ERCP pancreatitis, frailty status is associated with increased complications including all-cause mortality during hospitalization. Frail patients with PEP also have increased length of stay and total hospitalization costs during admission. Frailty assessments can thus be utilized as a predictor of outcomes and serve to guide clinical decision-making when determining prophylactic measures in patients undergoing ERCP who may be at risk for PEP.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Frailty as a Predictor of Outcomes in Patients with Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis \",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-04-17 10:36:44\",\"doi\":\"10.21203/rs.3.rs-6291035/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"9addd290-d577-43c8-b355-571451dcb7ce\",\"owner\":[],\"postedDate\":\"April 17th, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2025-04-30T19:23:17+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2025-04-17 10:36:44\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-6291035\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-6291035\",\"identity\":\"rs-6291035\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}