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High Rates of Readmission in Necrotizing Pancreatitis: Natural History or Opportunity for Improvement?

  • Thomas K. Maatman
  • Sarakshi Mahajan
  • Alexandra M. Roch
  • Kyle A. Lewellen
  • Mark A. Heimberger
  • Cameron L. Colgate
  • Eugene P. Ceppa
  • Michael G. House
  • Attila Nakeeb
  • C. Max Schmidt
  • Nicholas J. ZyromskiEmail author
Original Article
  • 15 Downloads

Abstract

Background

Necrotizing pancreatitis (NP) is a complex and heterogeneous disease with a protracted disease course. Hospital readmission is extremely common; however, few data exist regarding the cause of readmission in NP.

Methods

A retrospective review of NP patients treated between 2005 and 2017 identified patients readmitted both locally and to our hospital. All patients with unplanned hospital readmissions were evaluated to determine the cause for readmission. Clinical and demographic factors of all patients were recorded. As appropriate, two independent group t tests and Pearson’s correlation or Fisher’s exact tests were performed to analyze the relationship between index admission clinical factors and readmission. p values of < 0.05 were accepted as statistically significant.

Results

Six hundred one NP patients were reviewed. Median age was 52 years (13–96). Median index admission length of stay was 19 days (2–176). The most common etiology was biliary (49.9%) followed by alcohol (20.0%). Unplanned readmission occurred in 432 patients (72%) accounting for a total of 971 unique readmissions (mean readmissions/patient, 2.3). The most common readmission indications were symptomatic necrosis requiring supportive care and/or intervention (31.2%), infected necrosis requiring antibiotics and/or intervention (26.6%), failure to thrive (9.7%), and non-necrosis infection (6.6%). Patients requiring readmission had increased incidence of index admission renal failure (21.3% vs. 14.2%, p = 0.05) and cardiovascular failure (12.5% vs. 4.7%, p = 0.01).

Discussion

Readmission in NP is extremely common. Significant portions of readmissions are a result of the disease natural history; however, a percentage of readmissions appear to be preventable. Patients with organ failure are at increased risk for unplanned readmission and will benefit from close follow-up.

Keywords

Necrotizing pancreatitis Readmission Risk factors Organ failure 

Notes

Compliance with Ethical Standards

All data were compiled and recorded in strict compliance with the protocols and guidelines set forth by the Institutional Review Board (IRB), which approved the conduct of this study.

Conflict of Interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Fagenholz P, Fernández-del Castillo C, Harris N, Pelletier A, Camargo Jr. C. Direct Medical Costs of Acute Pancreatitis Hospitalizations in the United States. Pancreas. 2007;35(4):302–7.CrossRefGoogle Scholar
  2. 2.
    Howard TJ, Patel JB, Zyromski N, Sandrasegaran K, Yu J, Nakeeb A, Pitt HA, Lillemoe KD. Declining morbidity and mortality rates in the surgical management of pancreatic necrosis. J Gastrointest Surg. 2007;11(1):43–9.CrossRefGoogle Scholar
  3. 3.
    Kokosis G, Perez A, Pappas TN. Surgical Management of Necrotizing Pancreatitis: An Overview. World J Gastroenterol. 2014;20(43):16106–12.CrossRefGoogle Scholar
  4. 4.
    Freeman M, Werner J, van Santvoort H, Baron T, Besselink M, Windsor J, Horvath K, vanSonnenberg E, Bollen T, Vege S. Interventions for Necrotizing pancreatitis: Summary of a Multidisciplinary Consensus Conference. Pancreas. 2012;41(8):1176–94.CrossRefGoogle Scholar
  5. 5.
    Fischer C, Lingsma HF, Marang-van de Mheen PJ, Kringos DS, Klazinga NS, Steyerberg EW. Is the Readmission Rate a Valid Quality Indicator? A Review of the Evidence. PLOS One. 2014;9(11):e112282.CrossRefGoogle Scholar
  6. 6.
    Yadav D, Lee E, Papchristou G, O'Connell M. A Population-Based Evaluation of Readmissions After First Hospitalization for Acute Pancreatitis. Pancreas. 2014;43(4):630–7.CrossRefGoogle Scholar
  7. 7.
    Yadav D, O'Connell M, Papachristou GI. Natural history following the first attack of acute pancreatitis. Am J Gastroenterol. 2012;107(7):1096–103.CrossRefGoogle Scholar
  8. 8.
    Vipperla K, Papachristou GI, Easler J, Muddana V, Slivka A, Whitcomb DC, Yadav D. Risk of and factors associated with readmission after a sentinel attack of acute pancreatitis. Clin Gastroenterol Hepatol. 2014;12(11):1911–9.CrossRefGoogle Scholar
  9. 9.
    Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, Tsiotos GG, Vege SS, Acute Pancreatitis Classification Working G. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62(1):102–11.CrossRefGoogle Scholar
  10. 10.
    Marshall J, Cook D, Christou N, Bernard G, Sprung C, Sibbald W. Multiple Organ Dysfunction Score: A Reliable Descriptor of a Complex Clinical Outcome. Critical Care Medicine. 1995;23(10):1638–52.CrossRefGoogle Scholar
  11. 11.
    Working Group IAPAPAAPG. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 2013;13(4 Suppl 2):e1–15.Google Scholar
  12. 12.
    Idrees J, Rosinksi B, Merath K, Chen Q, Bagante F, Pawlik TM. Readmission after pancreatic resection: causes, costs, and cost-effectiveness analysis of high versus low quality hospitals using the Nationwide Readmission Database. HPB (Oxford). 2018; https://doi.org/10.1016/j.hpb.2018.07.011.
  13. 13.
    Whitlock TL, Repas K, Tignor A, Conwell D, Singh V, Banks PA, Wu BU. Early readmission in acute pancreatitis: incidence and risk factors. Am J Gastroenterol. 2010;105(11):2492–7.CrossRefGoogle Scholar
  14. 14.
    Whitlock TL, Tignor A, Webster EM, Repas K, Conwell D, Banks PA, Wu BU. A scoring system to predict readmission of patients with acute pancreatitis to the hospital within thirty days of discharge. Clin Gastroenterol Hepatol. 2011;9(2):175–80.CrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  • Thomas K. Maatman
    • 1
  • Sarakshi Mahajan
    • 1
  • Alexandra M. Roch
    • 1
  • Kyle A. Lewellen
    • 2
  • Mark A. Heimberger
    • 2
  • Cameron L. Colgate
    • 3
  • Eugene P. Ceppa
    • 1
  • Michael G. House
    • 1
  • Attila Nakeeb
    • 1
  • C. Max Schmidt
    • 1
  • Nicholas J. Zyromski
    • 1
    Email author
  1. 1.Department of SurgeryIndiana University School of MedicineIndianapolisUSA
  2. 2.Indiana University School of MedicineIndianapolisUSA
  3. 3.Center for Outcomes Research in Surgery (CORES)Indiana University School of MedicineIndianapolisUSA

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