Comparative Analysis of Outcomes and Readmissions Trends in Adult and Pediatric Acute Biliary Pancreatitis: A
Umer Farooq1, Zahid Ijaz Tarar2, Sagar Pathak3
1Division of Gastroenterology and Hepatology, Saint Louis University, Saint Louis, MO 63104.
Insights
Same-admission cholecystectomy significantly reduces 30-day readmissions for acute biliary pancreatitis (ABP) in both pediatric and adult patients. Outcomes and complications were similar across age groups, despite higher comorbidities in adults.
Area of Science:
- Gastroenterology and Hepatology
- Surgical Outcomes Research
- Pediatric Surgery
Background:
- Acute biliary pancreatitis (ABP) management varies between pediatric and adult patients.
- Understanding comparative outcomes is crucial for optimizing treatment strategies.
Purpose of the Study:
- To compare outcomes, resource use, and impact of same-admission cholecystectomy in pediatric versus adult patients with ABP.
- To evaluate the effectiveness of cholecystectomy in reducing readmissions across age groups.
Main Methods:
- Analysis of the 2016-2020 National Readmission Database for ABP patients.
- Comparison of local and systemic complications, mortality, and readmission rates between pediatric (<18) and adult (≥18) groups.
- Multivariate logistic regression and Mantel-Haenszel tests were used for statistical analysis.
Main Results:
- Pediatric patients constituted 1.54% of the 194,441 ABP cases.
- Systemic complications (sepsis higher in adults) and local complications were similar; mortality was comparable (0% vs. 0.71%).
- Same-admission cholecystectomy (CCY) reduced 30-day readmissions in both pediatric (11.81% to 5.55%) and adult (11.99% to 4.44%) groups.
Conclusions:
- Adults and pediatric patients with ABP show similar complication rates and mortality, despite higher adult comorbidities.
- Same-admission cholecystectomy is a vital intervention, significantly lowering 30-day readmissions for ABP in both pediatric and adult populations.
Objectives:
To assess the comparative outcomes, resource utilization, and overall impact of same-admission cholecystectomy in pediatric patients with acute biliary pancreatitis (ABP) relative to adults.
Methods:
Using the 2016-2020 National Readmission Database, we identified ABP patients via ICD-10 codes and compared local and systemic complications in adults (≥18) versus pediatric (<18) patients. Proportions were analyzed using Fisher's exact test, and multivariate logistic regression was performed, adjusting for age, gender, comorbidities, procedure volume, and patient and hospital factors. Readmission trends were assessed with the Mantel-Haenszel test. Analyses used Stata 14.2; P<0.05 was significant.
Results:
Among 194,441 ABP patients, 1.54% (n=2,999) were pediatric. Systemic complications of acute pancreatitis were similar, except sepsis was higher in adults (1.72% vs. 0.41%, P<0.01). Local complications, including pseudocyst, pancreatic necrosis, and walled-off necrosis, were comparable. Mortality was 0% vs. 0.71% (P=0.22). Same-admission cholecystectomy (CCY) was more common in pediatric cases; ERCP in adults. CCY reduced 30-day readmissions in both groups (11.81%→5.55% pediatric; 11.99%→4.44% adults, P<0.05). Pediatric CCY rates were stable longitudinally during study period; adult rates slightly increased (56.51%→57.23%, trend P=0.01).
Conclusion:
Despite higher comorbidities in adults, ABP-specific local and systemic complications and mortality were similar between adults and pediatric patients. Same-admission cholecystectomy (CCY) was associated with a significant reduction in 30-day readmissions in both groups, highlighting its importance as a key intervention across age groups in acute biliary pancreatitis (ABP) cases.
Related Concept Videos
01:30Acute Pancreatitis II: Clinical Manifestations and Management
01:29Chronic Pancreatitis II: Collaborative Care
Assessment:
01:25Acute Pancreatitis I: Introduction
01:21Acute Pancreatitis II: Pathophysiology