Rabin Neupane, MBBS1, Disha Sharma, MBBS1, Andrew Stevens, MD2, Bryan S. Stone, DO2, Wei Yan, MD2, Shandiz Shahbazi, MD2, Ilan Vavilin, MD2, Cory Higley, DO, MPH2, Albert C. Shu, MD2, Sandeep Nadella, MBBS2, Nadim G. Haddad, MD3; 1MedStar Washington Hospital Center, Washington, DC; 2MedStar Georgetown University Hospital, Washington, DC; 3MedStar Georgetown University Hospital, Potomac, MD
Introduction: Acute pancreatitis (AP) is a common gastrointestinal tract pathology which accounts for significant patient and financial burden. Alcohol and biliary causes including gallstones are the two most common causes of AP. In our large health system comprising of 9 hospitals, we determined the trends of patients presenting with Alcohol associated Acute Pancreatitis (AAP). Specifically, we characterized trends in diagnosis and adherence to treatment guidelines within our health system to ascertain gaps in performance. Methods: After obtaining IRB approval,we used ICD-10 codes to retrieve charts of patients admitted presenting to emergency departments within the MedStar Health System between March 2015- June 2019. 4,043 patient encounters were eligible for retrospective chart review, of which 2,542 charts with complete clinical information were manually reviewed. Variables pertaining to alcohol related AP was extracted including the demographics, symptoms, etiology work up, lipase levels, imaging, length of stay, complications of AP, and need for intensive care. Revised Atlanta classification was used to define the diagnosis of AP. Statistical analysis were performed including T-test, ANOVA using GraphPad PRISM for Mac OS (Version 8). Results: 1,903 patients out of 2,542 met revised Atlanta classification for AP despite all of them had the ICD-10 code for AP. AAP was the most common etiology noted in our cohort with 738 cases (29.0%).83.3% (615) of AAP patients met criteria for AP. AAP patients were less likely to have an etiology workup done compared to not alcohol associated AP (p=0.0002, Odds Ratio (0.71, 95%CI of 0.59-0.85). If there was active alcohol use documented, these patients were less likely to have a documented work up for AP, p=0.002(OR 0.73, 95%CI 0.62-0.86). The billing diagnosis for AAP had a sensitivity of 95% and specificity of 97%. Clinical criteria (pain) had a sensitivity of 97% and specificity of 12% respectively. Discussion: AAP is a major cause of AP within our cohort. The billing diagnosis frequently corroborates to the documented etiology when alcohol is involved. However, a significant portion of AP patients do not have a documented workup when alcohol use is noted in history, which may explain the inaccurate diagnosis. These represent avenues for targeted interventions to improve the adherence to AP guidelines across a large health management organization.
Graph showing the trend of diagnosis work up in ETOH associated and non ETOH associated acute pancreatitis
Graph showing the trend of diagnosis workup among patient who had active alcohol use and patient without active alcohol use.
Disclosures: Rabin Neupane indicated no relevant financial relationships. Disha Sharma indicated no relevant financial relationships. Andrew Stevens indicated no relevant financial relationships. Bryan Stone indicated no relevant financial relationships. Wei Yan indicated no relevant financial relationships. Shandiz Shahbazi indicated no relevant financial relationships. Ilan Vavilin indicated no relevant financial relationships. Cory Higley indicated no relevant financial relationships. Albert Shu indicated no relevant financial relationships. Sandeep Nadella indicated no relevant financial relationships. Nadim Haddad indicated no relevant financial relationships.