MedStar Georgetown University Hospital Washington, DC
Cory Higley, DO, MPH1, Albert C. Shu, MD1, Wei Yan, MD1, Rabin Neupane, MBBS2, Disha Sharma, MBBS2, Bryan S. Stone, DO1, Andrew Stevens, MD1, Shandiz Shahbazi, MD1, Ilan Vavilin, 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 cause of gastrointestinal (GI)-related hospitalizations in the US and the fourth leading GI illness associated with all-cause 30-day readmissions. Readmissions are associated with increased healthcare utilization as well as mortality from AP at one year. To minimize risk for readmissions, guidelines recommend smoking/alcohol cessation counseling and same-admission cholecystectomy for alcoholic and gallstone AP, respectively. We examined healthcare utilization trends for AP using encounters as a proxy within a large health system. Methods: ICD-10 codes for AP were used to identify patients who presented to emergency departments (ED) within the MedStar Health 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 extractable clinical information, 1,903 of which had AP as defined by Revised Atlanta Classification (RAC). Variables such as demographics, ever-history of AP, and recent AP within the past 30 days requiring an ED visit were collected. Statistical analysis was performed using GraphPad PRISM. Results: Of 1,903 patients who satisfied RAC for AP, 184 (9.67%) had represented within 30 days following discharge from index presentation. Of those who returned, 22.3% had gallstone pancreatitis and 27.7% had alcoholic pancreatitis as their diagnosis on index hospitalization. 39.7% of those with gallstone pancreatitis had a same-admission cholecystectomy. Those with ever-history of AP were more likely to return following discharge (OR 1.51, p = 0.0136); this effect was more pronounced in patients who had presented immediately prior to index encounter (OR 3.62, p < 0.001). Those who had a previous encounter within the past 30 days had a statistically significant longer length of stay. There was no statistically significant difference in need for ICU level of care between those who were admitted within past 30 days and those who were not. Discussion: Patients with prior encounters for AP are at increased risk for returning to an acute care site and thus increased healthcare utilization. These re-encounters tend to be associated with longer length of stays. Following guidelines and identifying subpopulations most at risk for readmissions would allow for targeted interventions to decrease healthcare utilization.
Disclosures: Cory Higley indicated no relevant financial relationships. Albert Shu indicated no relevant financial relationships. Wei Yan 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. Shandiz Shahbazi indicated no relevant financial relationships. Ilan Vavilin indicated no relevant financial relationships. Nadim Haddad indicated no relevant financial relationships. Sandeep Nadella indicated no relevant financial relationships.