E0001 - Early Feeding Rates in Acute Pancreatitis Is Associated With Decreased Length of Hospitalization

Award: Presidential Poster Award

Melanie Pascal, MD¹, Samantha Magier, MD, ME², Ahmad Nawaz, MD², Thiruvengadam Muniraj, MD, PhD², Kenneth W. Hung, MD, MS^2
1Dartmouth-Hitchcock Medical Center, Lebanon, NH; ²Yale University School of Medicine, New Haven, CT

Introduction: Guidelines recommend that patients with acute pancreatitis (AP) receive early oral or enteral feeding within 24 hours of diagnosis rather than keeping patients nil per os. Early feeding reduces rates of multiorgan failure and necrotizing pancreatitis. We sought to understand whether early feeding affected length of hospitalization for AP, identify factors associated with early feeding, and determine whether an order set for acute pancreatitis would improve early feeding rates.

Methods: We identified adult patients (age ≥18 years) hospitalized at Yale New Haven Hospital, a tertiary academic medical center with a diagnosis of AP by ICD-10 code and/or serum lipase ≥3 times the upper limit of normal from April 2019-January 2021 and reviewed their charts to confirm the diagnosis of AP and the timing of diet order entry. We created and implemented an electronic medical record order set for AP including guidelines and diet, imaging, and consult orders in October 2020 (Figure 1). E-mails were sent to notify hospitalists and medicine residents of the order set. Primary outcome was the proportion of patients who received a diet order within 24 hours following diagnosis of AP. Logistic regression was performed to evaluate the relationship between early feeds within 24 hours of AP diagnosis and patient factors.

Results: A total of 707 patients were hospitalized with AP, and 496 patients (70.2%) had enteral feeds within 24 hours of AP diagnosis.

Patients receiving early feeds had shorter hospitalizations compared to patients receiving delayed feeds (mean [standard deviation] 8.4 days [12.8] versus 5.4 days [8.2]) (p < 0.01) and were less likely to be hospitalized in the intensive care unit (ICU) (odds ratio 0.45, 95% confidence interval 0.32-0.63) (Table 1).

There was no difference in gender, race, ethnicity between patients who received feeds within 24 hours of AP diagnosis and those who received feeds > 24 hours after AP diagnosis.

Implementation of an order set containing guidelines and orders for diet, imaging, and consults did not significantly improve early feeding within 24 hours of AP diagnosis (70.5% versus 68.9%) likely due to limited usage by providers.

Discussion: Early enteral nutrition is associated with shorter hospitalizations among patients with AP. Patients receiving oral or enteral feeds within 24 hours of AP diagnosis were less likely to be in the ICU. Durable and effective quality improvement initiatives are needed to improve rates of early enteral feeding in patients with AP.




Disclosures:


Melanie Pascal, MD¹, Samantha Magier, MD, ME², Ahmad Nawaz, MD², Thiruvengadam Muniraj, MD, PhD², Kenneth W. Hung, MD, MS². E0001 - Early Feeding Rates in Acute Pancreatitis Is Associated With Decreased Length of Hospitalization, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.