Cholecystectomy During Index Admission for Acute Biliary Pancreatitis Lowers 30-Day Readmission Rates. Issue 8 (September 2018) - Krishna, Somashekar G.
Abstract : Objectives: Few studies have evaluated national readmission rates after acute pancreatitis (AP) in the United States. We sought to evaluate modifiable factors impacting 30-day readmissions after AP hospitalizations. Methods: We used the Nationwide Readmission Database (2013) involving all adults with a primary discharge diagnosis of AP. Multivariable logistic regression models assessed independent predictors for specific outcomes. Results: Among 180, 480 patients with AP index admissions, 41, 094 (23%) had biliary AP, of which 10.5% were readmitted within 30 days. The 30-day readmission rate for patients who underwent same-admission cholecystectomy (CCY) was 6.5%, compared with 15.1% in those who did not ( P < 0.001). Failure of index admission CCY increased the risk of readmissions (odds ratio [OR], 2.27; 95% confidence interval [CI], 2.04–2.56). Same-admission CCY occurred in 55% (n = 19, 274) of patients without severe AP. Severe AP (OR, 0.73; 95% CI, 0.65–0.81), sepsis (OR, 0.63; 95% CI, 0.52–0.75), 3 or more comorbidities (OR, 0.74; 95% CI, 0.68–0.79), and admissions to small (OR, 0.76; 95% CI, 0.64–0.91) or rural (OR, 0.78; 95% CI, 0.65–0.95) hospitals were less likely to undergo same-admission CCY. Conclusions: Same-admission CCY should be considered in patients with biliary AP when feasible. This national appraisal recognizes modifiable risk factors to reduce readmission in biliary AP and reinforces adherence to major society guidelines. Abstract : Supplemental digital content is available in the text.