E0011 - Two Decades of Trends in Acute Biliary Pancreatitis in Women and the Impact of Management Guidelines

Tuesday, October 25, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

Ayushi Jain, MD

The Ohio State University Wexner Medical Center
Columbus, OH

Ayushi Jain, MD, Yevgeniya Gokun, MS, Georgios Papachristou, MD, Luis Lara, MD, Samuel Han, MD, Peter Lee, MBChB, Somashekar G. Krishna, MD, MPH
The Ohio State University Wexner Medical Center, Columbus, OH

Introduction: An estimated 12% of women will develop cholelithiasis during pregnancy. Nearly 70% of cases of acute pancreatitis in pregnancy are attributable to gallstone disease. Acute biliary pancreatitis (ABP) during pregnancy can cause serious morbidity, but there is a paucity of literature on how outcomes and management of ABP in pregnancy have changed with time. Hence, we sought to study trends of ABP and its management in pregnant women over the last two decades at a national level.

Methods: We used the National (Nationwide) Inpatient Sample to identify all women (≥18 years) with an inpatient admission for ABP in the United States from 2002 to 2018. We excluded data from 2015-2016 due to less than expected incidence attributable to a transition from the ICD-9 to ICD-10 coding system. Baseline patient characteristics were compared between pregnant and non-pregnant women with ABP utilizing Chi-square and two sample t-tests. Trends in outcomes and management were analyzed using Cochran-Armitage and F-Tests.

Results: Among 40,359 pregnant patients and 476,965 non-pregnant women hospitalized for ABP, a higher proportion of pregnant women with ABP were Hispanic (p< 0.001) and used Medicaid (p< 0.001) than non-pregnant women on univariate analysis (Table 1). Trend analyses from 2002-2018 revealed an increasing proportion (p< 0.001) of ABP admissions in pregnant females (Figure 1). An increasing trend was observed for ERCP (p< 0.001) and cholecystectomy (p< 0.001) in pregnant women admitted for ABP (Figure 1). Severe acute pancreatitis increased in both pregnant and non-pregnant patients across time, but a lower increase was seen in the pregnant cohort. Overall mortality in the pregnant cohort remained low (< 0.1%), ICU admission was less than 0.6%, and mean length of stay decreased from 5 days to 4 days (p< 0.001) for pregnant women with ABP.

Discussion: Over the last two decades, an increasing proportion of pregnant women are admitted with ABP, and therapeutic interventions (ERCP and cholecystectomy) are occurring more frequently with favorable hospital outcomes. These national-level data strongly support current surgical and endoscopic management guidelines of ABP in pregnancy.

Figure: Figure 1: Trends in Acute Biliary Pancreatitis in Non-Pregnant and Pregnant Women

Variable	Non-Pregnant (n=476,965)		Pregnant (n=40,359)		p-value
	n	%	n	%
Age (mean, SE)	55.97	0.14	26.12	0.07	< 0.0001
Race
White	251,213	52.67	14,326	35.5	< 0.0001
Black	45,633	9.57	3,668	9.09
Hispanic	81,010	16.98	13,645	33.81
Other/Missing	99,110	20.78	8,719	21.6
Median Income
Low (0-25^th percentile)	129,345	29.66	12,303	32.63	< 0.0001
Moderate (26^th to 50^th percentile)	115,539	26.5	10,597	28.11
High (51^st to 75^th percentile)	104,546	23.97	9,168	24.32
Very High (76^th to 100^th percentile)	86,648	19.87	5,633	14.94
Type of Insurance
Medicare	183,908	38.62	358	0.89	< 0.0001
Medicaid	74,005	15.54	21,620	53.68
Private	156,631	32.89	14,291	35.48
Other, self-pay, no charge	61,623	12.94	4,009	9.95
Type of Hospital
Rural	61,686	12.97	3,608	8.98	< 0.0001
Urban non-teaching	203,194	42.74	15,545	38.7
Urban teaching	210,542	44.29	21,014	52.32
Hospital bed size
Small	70,512	14.83	4,421	11.01	< 0.0001
Medium	132,502	27.87	10,778	26.83
Large	272,408	57.3	24,966	62.16
Hospital region
Northeast	83,151	17.43	5,440	13.48	< 0.0001
Midwest or North Central	100,177	21	7,850	19.45
South	182,145	38.19	15,535	38.49
West	111,491	23.38	11,533	28.58
AHRQ-Elixhauser Index
< 3	317,136	66.49	37,201	92.18	< 0.0001
≥3	159,828	33.51	3,157	7.82	< 0.0001
Admission Day
Weekday (Mon-Fri)	347,061	72.77	29,322	72.65	0.8329
Weekend (Sat-Sun)	129,899	27.23	11,037	27.35	0.8329

Table: Table 1. Baseline Characteristics for Females Admitted with Acute Biliary Pancreatitis

Disclosures:

Ayushi Jain indicated no relevant financial relationships.

Yevgeniya Gokun indicated no relevant financial relationships.

Georgios Papachristou indicated no relevant financial relationships.

Luis Lara: AbbVie – Consultant, Speakers Bureau.

Samuel Han indicated no relevant financial relationships.

Peter Lee indicated no relevant financial relationships.

Somashekar Krishna indicated no relevant financial relationships.

Ayushi Jain, MD, Yevgeniya Gokun, MS, Georgios Papachristou, MD, Luis Lara, MD, Samuel Han, MD, Peter Lee, MBChB, Somashekar G. Krishna, MD, MPH. E0011 - Two Decades of Trends in Acute Biliary Pancreatitis in Women and the Impact of Management Guidelines, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.