Predictors of hemodynamic instability during ERCP sedation in older adults: impact of sedation strategy in a retrospective cohort.

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.