PATIENTS READMITTED WITH GALLSTONE ACUTE PANCREATITIS HAVE HIGHER MORTALITY THAN THE INDEX HOSPITALIZATION: OUTCOMES AND PREDICTORS OF THIRTY-DAY READMISSIONS.
Pedro Palacios Argueta1, Miguel Salazar1, Juan E. Corral2, John J. Vargo3, John Rodriguez3, Prabhleen Chahal3, C. Roberto Simons-Linares*3
1Cook County Health & Hospital System (CCHHS), Chicago, IL; 2Mayo Clinic Florida, Jacksonville, FL; 3Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH
Background
Gallstone acute pancreatitis (GAP) is among the most common causes of acute pancreatitis in the United states. There is limited evidence regarding causes, predictors and outcomes of readmission after an index GAP episode.
Methods
Cohort study using the 2016 National Readmission Database (NRD) of adult patients readmitted after an index admission to the hospital due to GAP. ICD-10CM/PCS codes were used to identify GAP, outcomes, other comorbidities and procedures. We identified the most common causes for readmission and independent risk factors for readmission were identified using Cox regression analysis.
Results
A total of 8,026 patients were discharged with a primary diagnosis of GAP out of which 8.8% (n=718) were readmitted to the hospital within 30 days of discharge. The number one cause of readmission was another episode of GAP (14.7%) (code: K85.10), followed by acute pancreatitis episode of unspecified etiology (12.5%) (code: K85.90). The inpatient mortality was higher in readmitted patients compared to the mortality of the index GAP episode (2.1% vs. 1.2%; P=0.04). Readmitted patients were less likely to be female (49.7% vs. 58.6%; P<0.01 and obese (17.2% vs. 24.6%; P<0.01); and more likely to undergo cholecystectomy (CCY) (56.2% vs. 16.3%; P=<0.01) and endoscopic retrograde cholangiopancreatography (ERCP) (68.9% vs. 29.9%; P=<0.01). Readmitted patients had higher rates of opioid abuse (1.8% vs. 0.7%; P=0.02) and malnutrition (14.9% vs. 4.6%; P=<0.01). A total of 3,521 days was associated with readmission and the total of health care in-hospital economic burden of readmission was $35.1 million (in charges) and $8.2 million (in costs). Independent predictors of readmission were: cirrhosis (HR 1.78; P=0.02), malnutrition (HR 1.82; P=0.02), acute kidney injury during index admission (HR1.57; P=0.04), and history of pancreatic duct drainage/intervention (HR 2.53; P=0.03). CCY during index admission is associated with a significant lower risk of readmission (HR 0.71; P=0.04).
Conclusion
Gallstone acute pancreatitis patients are likely to be readmitted with another episode of pancreatitis. The readmission episode is associated with higher inpatient mortality and poses a significant burden to the health care system. Importantly, index admission cholecystectomy decreases the risk of readmission and mortality and should be considered in all GAP patients.
Table 1: Patient characteristics
Table 2: Predictors of readmission
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