BMC geriatrics · 2026
Predictors of hemodynamic instability during ERCP sedation in older adults: impact of sedation strategy in a retrospective cohort.
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Eşbah Ali Ümit, Torun Serkan
Аннотация
BACKGROUND: Older adults undergoing endoscopic retrograde cholangiopancreatography (ERCP) are particularly vulnerable to sedation-related hemodynamic instability. This study aimed to evaluate predictors of hemodynamic instability and the association between sedation strategy and hemodynamic outcomes in elderly patients.
METHODS: This retrospective cohort study included patients aged ≥ 65 years who underwent ERCP under deep sedation between 2015 and 2025. Hemodynamic instability was defined as either a ≥ 30% reduction in mean arterial pressure or vasopressor requirement. Multivariable logistic regression and inverse probability of treatment weighting (IPTW) were performed.
RESULTS: A total of 150 patients were included, and hemodynamic instability occurred in 46 (30.7%). Advanced age, ASA class III-IV, lower baseline mean arterial pressure, and prolonged procedure duration were associated with increased instability risk. Ketofol use was associated with lower odds of hemodynamic instability than propofol alone (aOR: 0.50, 95% CI: 0.25-0.99, p = 0.047), with consistent findings after IPTW (OR: 0.55, 95% CI: 0.31-0.98, p = 0.043).
CONCLUSIONS: Hemodynamic instability is common during ERCP in older adults. Ketofol use was associated with lower observed hemodynamic instability; however, residual confounding cannot be excluded because of the retrospective non-randomized design.
CLINICAL TRIAL REGISTER: Not applicable.
METHODS: This retrospective cohort study included patients aged ≥ 65 years who underwent ERCP under deep sedation between 2015 and 2025. Hemodynamic instability was defined as either a ≥ 30% reduction in mean arterial pressure or vasopressor requirement. Multivariable logistic regression and inverse probability of treatment weighting (IPTW) were performed.
RESULTS: A total of 150 patients were included, and hemodynamic instability occurred in 46 (30.7%). Advanced age, ASA class III-IV, lower baseline mean arterial pressure, and prolonged procedure duration were associated with increased instability risk. Ketofol use was associated with lower odds of hemodynamic instability than propofol alone (aOR: 0.50, 95% CI: 0.25-0.99, p = 0.047), with consistent findings after IPTW (OR: 0.55, 95% CI: 0.31-0.98, p = 0.043).
CONCLUSIONS: Hemodynamic instability is common during ERCP in older adults. Ketofol use was associated with lower observed hemodynamic instability; however, residual confounding cannot be excluded because of the retrospective non-randomized design.
CLINICAL TRIAL REGISTER: Not applicable.