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Association between acute peripancreatic fluid collections and early readmission in acute pancreatitis: A
Hassam Ali1, Faisal Inayat2, Waqas Rasheed3
1Department of Gastroenterology and Hepatology, East Carolina University Brody School of Medicine, Greenville, NC 27834, United States.
Insights
Acute peripancreatic fluid collection (APFC) in patients with acute pancreatitis (AP) significantly increases 30-day readmission risk, inpatient complications, and healthcare costs. Identifying APFC early can help manage high-risk patients and reduce burdens.
Area of Science:
- Gastroenterology
- Clinical Medicine
- Health Services Research
Background:
- Acute pancreatitis (AP) is a common cause of hospital readmissions.
- Acute peripancreatic fluid collection (APFC) may worsen AP outcomes, but its link to early readmission is unclear.
Purpose of the Study:
- To evaluate the association between APFC and 30-day readmission in patients diagnosed with AP.
Main Methods:
- Retrospective cohort study using the 2016-2019 Nationwide Readmission Database.
- Propensity score matching (1:1) for age, gender, and comorbidities.
- Cox regression models to assess 30-day readmission risk (aHR).
Main Results:
- APFC was present in 5.1% of AP patients and associated with higher inpatient complications (e.g., septic shock, portal venous thrombosis).
- APFC patients had significantly higher 30-day readmission rates (15.7% vs. 6.5%) and longer hospital stays.
- APFC presence more than doubled the risk of 30-day readmission (aHR 2.52).
Conclusions:
- APFC during initial AP hospitalization is a significant predictor of higher readmission rates, increased complications, and elevated healthcare costs.
- Identifying APFC and other risk factors can guide targeted interventions for high-risk AP patients, potentially reducing healthcare system burden.
Background:
Patients with acute pancreatitis (AP) frequently experience hospital readmissions, posing a significant burden to healthcare systems. Acute peripancreatic fluid collection (APFC) may negatively impact the clinical course of AP. It could worsen symptoms and potentially lead to additional complications. However, clinical evidence regarding the specific association between APFC and early readmission in AP remains scarce. Understanding the link between APFC and readmission may help improve clinical care for AP patients and reduce healthcare costs.
Aim:
To evaluate the association between APFC and 30-day readmission in patients with AP.
Methods:
This retrospective cohort study is based on the Nationwide Readmission Database for 2016-2019. Patients with a primary diagnosis of AP were identified. Participants were categorized into those with and without APFC. A 1:1 propensity score matching for age, gender, and Elixhauser comorbidities was performed. The primary outcome was early readmission rates. Secondary outcomes included the incidence of inpatient complications and healthcare utilization. Unadjusted analyses used Mann-Whitney U and χ 2 tests, while Cox regression models assessed 30-day readmission risks and reported them as adjusted hazard ratios (aHR). Kaplan-Meier curves and log-rank tests verified readmission risks.
Results:
A total of 673059 patients with the principal diagnosis of AP were included. Of these, 5.1% had APFC on initial admission. After propensity score matching, each cohort consisted of 33914 patients. Those with APFC showed a higher incidence of inpatient complications, including septic shock (3.1% vs 1.3%, P < 0.001), portal venous thrombosis (4.4% vs 0.8%, P < 0.001), and mechanical ventilation (1.8% vs 0.9%, P < 0.001). The length of stay (LOS) was longer for APFC patients [4 (3-7) vs 3 (2-5) days, P < 0.001], as were hospital charges ($29451 vs $24418, P < 0.001). For 30-day readmissions, APFC patients had a higher rate (15.7% vs 6.5%, P < 0.001) and a longer median readmission LOS (4 vs 3 days, P < 0.001). The APFC group also had higher readmission charges ($28282 vs $22865, P < 0.001). The presence of APFC increased the risk of readmission twofold (aHR 2.52, 95% confidence interval: 2.40-2.65, P < 0.001). The independent risk factors for 30-day readmission included female gender, Elixhauser Comorbidity Index ≥ 3, chronic pulmonary diseases, chronic renal disease, protein-calorie malnutrition, substance use disorder, depression, portal and splenic venous thrombosis, and certain endoscopic procedures.
Conclusion:
Developing APFC during index hospitalization for AP is linked to higher readmission rates, more inpatient complications, longer LOS, and increased healthcare costs. Knowing predictors of readmission can help target high-risk patients, reducing healthcare burdens.
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