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HIGH READMISSION RATE IN NECROTISING PANCREATITIS: QUALITY INDEX OR NATURAL HISTORY OF DISEASE?
Sarakshi Mahajan*, Thomas Maatman, Carl Schmidt, Eugene P. Ceppa, Michael G. House, Nicholas J. Zyromski
Department of Surgery, IUPUI, Indianapolis, IN
Background: Necrotizing pancreatitis (NP) is a complex disease that is associated with long hospitalization, multiple interventions, and often requires numerous months to resolve. Hospital readmission in NP is common; however, to date few data exist regarding specific reason for readmission. We therefore sought to determine the incidence and reason for hospital readmission in a large cohort of NP patients.
Methods: With IRB approval, retrospective analysis of NP patients treated between January 2005 and December 2016 was undertaken. Clinical and demographic data were abstracted. Chart review identified incidence and specific reason for readmission within the first year of the disease. Reasons for readmission were categorized as abdominal pain, infection (abdominal/necrosis, pulmonary, urinary, blood stream, other), dehydration, recurrent acute pancreatitis, hemorrhage, malnutrition, cardiac, renal, and elective procedure. Descriptive statistical analysis was applied as appropriate.
Results: A total of 624 NP patients were treated during this time period. The median age was 53 years, and 60% were male. Biliary etiology was most common (n = 271 - 43%), followed by alcohol in (n = 127 -20%), and idiopathic (n = 113 - 18%). A total of 442 (71%) patients required readmission to the hospital. Readmission occurred a mean of 2.6 (range; 0-7) readmissions (range 0-9). The median length of hospital stay (LOS) for the index admission was 21 days (range 12-38), and the median LOS for the first readmission was 9 days (range 5-17). The most common reason for readmission was abdominal pain (n = 189 - 42%); however, 44 (23%) of these 189 patients had concomitant infection. Reasons for readmissions are described in table 1.
Conclusion: Readmission in necrotizing pancreatitis patients is extremely common. While specific reasons for readmission in this population reflect disease course, opportunity to decrease readmission rate clearly exists.
Causes for readmission
| Abdominal Pain | 324 (73%) | | Elective Procedure | 167 (38%) | | Infections | 114 (26%) | | Malnutrition | 113(26%) | | Recurrent Acute Pancreatitis | 105 (23%) | | Dehydration | 59 (13%) | | Hemorrhage | 35 (8%) | | Renal Complications | 14 (3%) | | Cardiac Complications | 6(1%) | | | |
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