Resident Physician Allegheny Health Network Pittsburgh, Pennsylvania
Shifa Umar, MD1, Ronald Samuel, MD2, Aun R. Shah, MD, MRCP3, Saurabh Chandan, MD3, Mohammad Bilal, MD4, Rubab Ali, MBBS5, Zarak Khan, MD6, Ahmad Najdat Bazarbashi, MD7, Marwan S. Abougergi, MD8, Madhav Desai, MD, MPH9, Paul T. Kroner, MD, MSc10, Vaibhav Wadhwa, MD11, Shailendra Singh, MD12, Yasmin Hernandez-Barco, MD13; 1Allegheny Health Network, Pittsburgh, PA; 2University of Texas Medical Branch, Galveston, TX; 3University of Nebraska Medical Center, Omaha, NE; 4Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; 5Shifa College of Medicine, Islamabad, Islamabad, Pakistan; 6St. Mary Mercy Hospital, Livonia, MI; 7Brigham & Women's Hospital, Somerville, MA; 8University of South Carolina, Columbia, SC; 9Kansas City VA Medical Center, Kansas City, MO; 10Mayo Clinic, Jacksonville, FL; 11Cleveland Clinic Florida, Weston, FL; 12West Virginia University, Charleston, WV; 13Massachusetts General Hospital, Boston, MA
Introduction: We sought to determine the 11-month readmission rate (RR) for various etiologies of AP after an initial episode of AP; and compare the outcomes and healthcare resource utilization associated with each of them. Methods: Retrospective cohort study using the 2016 National Readmission Database (NRD). Inclusion criteria were: principal diagnosis of AP and admission in January 2016. All readmissions to any hospital for a principal diagnosis of AP within 11 months of the index admission were recorded for each patient. Patients were divided into 5 groups based on etiology of AP and primary outcome was the 11-month RR of AP. Secondary outcomes were: number of readmissions per year in each group, index admission and calendar year mortality, treatment/management variations in each group and healthcare resource utilization. Results: 22,472 patients hospitalized with AP in January 2016 were included. Common etiologies were biliary (16.7%), alcohol (24.1%), drug-induced (1.6%), other (54.5%) and idiopathic (3.2%). The mean age was 53 years and 41.6% were males. The 11-month RRs for biliary, alcoholic, drug-induced, other and idiopathic AP were 7.6%, 36.2%, 10.7%, 23% and 23.7%, respectively. Over 6% of patients with alcohol-induced AP and 9.3% of patients with drug-related AP had > 5 readmissions in the 11-month follow-up period [Figure 1]. Index admission mortality was highest in biliary pancreatitis (1%), while the calendar year mortality was higher in patients with other etiologies of AP (1.8%). Rates of percutaneous drainage were highest in patients with biliary AP (4.9%); while patients with idiopathic pancreatitis underwent the highest number of necrosectomies (0.5%) and had the highest need for TPN (1.5%). Patients with alcohol-induced AP had the highest rates of feeding tube placement (0.6%). Healthcare resource utilization was the highest in readmitted patients with alcohol-induced and other etiologies of AP as compared to biliary, idiopathic and drug-induced AP. Total hospital days associated with alcohol-induced AP related readmissions were 16,012 days with total healthcare costs of $114 million, while total hospital days with other AP were 25,578 days and total healthcare costs of $178 million [Figure 2]. Discussion: Our study provides national data on the calendar year RR of patients with AP across different etiologies, and the impact on outcomes related to readmission. The highest RR are associated with alcohol induced AP with a significant impact on healthcare resource utilization.
Figure 1: Clinical outcomes associated with various etiologies of acute pancreatitis
Figure 2: Healthcare Utilization Measures
Disclosures: Shifa Umar indicated no relevant financial relationships. Ronald Samuel indicated no relevant financial relationships. Aun Shah indicated no relevant financial relationships. Saurabh Chandan indicated no relevant financial relationships. Mohammad Bilal indicated no relevant financial relationships. Rubab Ali indicated no relevant financial relationships. Zarak Khan indicated no relevant financial relationships. Ahmad Najdat Bazarbashi indicated no relevant financial relationships. Marwan Abougergi indicated no relevant financial relationships. Madhav Desai indicated no relevant financial relationships. Paul Kroner indicated no relevant financial relationships. Vaibhav Wadhwa indicated no relevant financial relationships. Shailendra Singh indicated no relevant financial relationships. Yasmin Hernandez-Barco indicated no relevant financial relationships.