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J Gastrointest Surg. 2019 Sep;23(9):1834-1839. doi: 10.1007/s11605-018-04097-6. Epub 2019 Jan 31.

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

Author information

1
Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH 519, Indianapolis, IN, 46202, USA.
2
Indiana University School of Medicine, Indianapolis, IN, USA.
3
Center for Outcomes Research in Surgery (CORES), Indiana University School of Medicine, Indianapolis, IN, USA.
4
Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH 519, Indianapolis, IN, 46202, USA. nzyromsk@iupui.edu.

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; Organ failure; Readmission; Risk factors

PMID:
30706374
DOI:
10.1007/s11605-018-04097-6

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