MedStar Georgetown University Hospital Washington, DC
Shandiz Shahbazi, MD1, Cory Higley, DO, MPH1, Ilan Vavilin, MD1, Wei Yan, MD1, Albert C. Shu, MD1, Rabin Neupane, MBBS2, Disha Sharma, MBBS2, Bryan S. Stone, DO1, Andrew Stevens, MD1, Nadim G. Haddad, MD3, Sandeep Nadella, MBBS1; 1MedStar Georgetown University Hospital, Washington, DC; 2MedStar Washington Hospital Center, Washington, DC; 3MedStar Georgetown University Hospital, Potomac, MD
Introduction: Acute pancreatitis (AP) is the third most common gastrointestinal inpatient diagnosis, thereby accounting for significant patient and financial burden. Gallstone AP (GAP) is one of the most common causes of AP in the United States. Guidelines for diagnosis, and management of GAP recommend appropriate criteria for diagnosis, imaging as part of the workup and same-admission cholecystectomy. We characterized trends in diagnosis and adherence to treatment guidelines of patients presenting with GAP in a large healthcare system. Methods: ICD-10 codes for AP were used to identify patients who presented to emergency departments (ED) within the MedStar Health (a nine hospital system) between March 2015 and June 2019. 4,043 patient encounters were eligible for retrospective chart review; these included ED visits and inpatient admissions. Manual review yielded 2,542 charts with complete clinical information. We collected several variables pertaining to the management of GAP including but not limited to demographics, clinical symptoms, laboratory results, imaging, procedures, treatment and outcome variables. Statistical analysis was performed with PRISM (Ver 8.2.1, Graphpad). Results: Out of 2,542 patients diagnosed with AP, 454 were attributed to GAP, of which 401 met Revised Atlanta Classification. The remaining 53 patients did not meet criteria but were labeled as GAP in the presence of gallstones on imaging. 95.8% of patients with GAP presented with pain and 82.4% had elevated lipase and those with prior history of choledocholithiasis were 4.37 times more likely to have GAP (p< 0.0001). About 97.6% of patient labeled with GAP got imaging during the admission but were no more likely to have evidence of gallstones on imaging (OR 1.10, p=0.3650). Although patients with GAP are 2.48 times (p< 0.0001) more likely to have their etiological workup documented, it is still only documented 62.1% of the time. Despite the diagnosis of GAP, only 34.6% of patients (157/454) got cholecystectomy during the admission. Discussion: The diagnosis of GAP may be erroneously made. In most cases of GAP, it could be the first and only presentation of gallstones. Despite the imaging study being positive for gallstones, appropriate workup for other causes of AP must be done, as a possible etiology can be missed. With the new guidelines focusing on early surgical management for GAP, these numbers could help drive improvements in quality of care in order to prevent recurrence.
Disclosures: Shandiz Shahbazi indicated no relevant financial relationships. Cory Higley indicated no relevant financial relationships. Ilan Vavilin indicated no relevant financial relationships. Wei Yan indicated no relevant financial relationships. Albert Shu indicated no relevant financial relationships. Rabin Neupane indicated no relevant financial relationships. Disha Sharma indicated no relevant financial relationships. Bryan Stone indicated no relevant financial relationships. Andrew Stevens indicated no relevant financial relationships. Nadim Haddad indicated no relevant financial relationships. Sandeep Nadella indicated no relevant financial relationships.