The Ohio State University Wexner Medical Center Columbus, OH
Brandon K. Chu, MD1, Bipul Gnyawali, BS2, Luis L. Lara, MD1, Jordan Cloyd, MD3, Alice Hinton, PhD3, Philip Hart, MD1, Georgios I. Papachristou, MD, PhD4, Jeffrey R. Groce, MD, MS1, Darwin L. Conwell, MD, MS3, Somashekar G. Krishna, MD, MPH1; 1The Ohio State University Wexner Medical Center, Columbus, OH; 2The Ohio State University College of Medicine, Columbus, OH; 3The Ohio State University, Columbus, OH; 4Ohio State University, Columbus, OH
Introduction: Patients with acute biliary pancreatitis (ABP) should undergo same-admission cholecystectomy (CCY) when indicated since it reduces the risk of 30-day readmission and recurrent acute pancreatitis. We sought to investigate the reasons and predictors for early-unplanned readmission following same-admission CCY for an index episode of ABP. Methods: Using the Nationwide Readmission Database (2010-2014), we identified all adults (age ≥18 years) with a principle diagnosis of ABP who had undergone CCY during the index hospitalization. Patients with a diagnosis of chronic pancreatitis, pancreatic neoplasm, pregnancy, and those who died during index admission or were discharged in the month of December were excluded. Severe acute pancreatitis (severe-AP) was defined by the revised Atlanta classification. Multivariable logistic regression models were obtained to assess independent predictors for 30-day readmission. Principal diagnosis for all readmissions was collected to ascertain the key reasons for early readmission. Results: During the study period, 118,224 patients underwent same-admission CCY for ABP. The rate of early (30-day) unplanned readmission was 7.25% (n=8,574).
Following multivariable analysis (Table 1), predictors for readmission included male gender (odds ratio [OR] 1.18, 95% confidence interval [CI] 1.08-1.28), insurance type (Medicare insurance [OR 1.26, 95% CI 1.13-1.40]; Medicaid [OR 1.22, 95% CI 1.09-1.38]), discharge other than home (OR 1.35, 95% CI 1.16-1.57), severe-AP (OR 1.35, 95% CI 1.21-1.50), and ≥3 Elixhauser comorbidities (OR 1.55, 95% CI 1.41-1.69). Variables associated with decreased risk of early readmission included performance of intraoperative cholangiogram (IOC) (OR 0.90, 95% CI 0.82-0.97), and ERCP (OR 0.81, 95% CI 0.73-0.89).
Exacerbation of prior medical conditions, urinary tract infections, pneumonias, and C. Difficile infections accounted for 45% of early-unplanned readmissions (Table 2). Sequelae (i.e. pancreatic fluid collection) of or recurrent acute pancreatitis accounted for 34% and surgical complications due to CCY or uncontrolled postoperative symptoms accounted for 21% of the readmissions. Discussion: This national appraisal recognizes modifiable risk factors, such as performing IOC and ERCP when indicated, and identifies preventable causes for early-unplanned readmissions following ABP with same-admission CCY.
Disclosures: Brandon Chu indicated no relevant financial relationships. Bipul Gnyawali indicated no relevant financial relationships. Luis Lara: Abbvie – Consultant, Speaker's Bureau. Allergan – Speaker's Bureau. Medtronic – Consultant, Speaker's Bureau. Jordan Cloyd indicated no relevant financial relationships. Alice Hinton indicated no relevant financial relationships. Philip Hart indicated no relevant financial relationships. Georgios Papachristou indicated no relevant financial relationships. Jeffrey Groce indicated no relevant financial relationships. Darwin Conwell indicated no relevant financial relationships. Somashekar Krishna indicated no relevant financial relationships.