Incidence and predictors of 30-day readmissions in patients hospitalized with chronic pancreatitis: A nationwide analysis

Shah, Rushikesh; Haydek, Christopher; Mulki, Ramzi; Qayed, Emad

doi:10.1016/j.pan.2018.04.006

Cited by 29 publications

(19 citation statements)

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“…As such, the authors conclude that appropriate surgical management, including performing a cholecystectomy prior to discharge where indicated, should be accomplished, in keeping with previous studies supporting cholecystectomy during the index admission rather than after discharge in order to diminish readmission rates for pancreaticobiliary complications [3,4]. Chronic pancreatitis is associated with frequent readmissions with as many as one in four patients readmitted within 30 days [5] which likely accounts in part for the increased odds of readmission in this study for the subgroup of patients that had a pancreatic stent placed for pancreatic endotherapy. Similarly, liver transplant patients and cirrhotics have high readmission rates due to underlying disease regardless of whether they have had an ERCP [6].The majority of readmissions in patients who have had an inpatient ERCP may not be preventable as they are either unrelated to pancreaticobiliary complications or are associated with underlying conditions with known high readmission rates such as chronic liver disease or pancreatitis.Nonetheless, patients with complications of biliary stones such as cholangitis or biliary pancreatitis who have an intact gallbladder should undergo early ERCP during the index admission followed by cholecystectomy prior to discharge if clinically appropriate.…”

supporting

confidence: 69%

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confidence: 69%

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Concise Commentary: A Stitch in Time—Prophylactic Cholecystectomy Can Reduce Readmission After ERCP

Gordon

2020

Dig Dis Sci

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Thirty-day readmission rates have been increasingly used as an outcome measure and quality benchmark in health services research. While there are known complications associated with ERCP, there are limited data on readmission rates following ERCP.In this issue of Digestive Diseases and Sciences, Krill et al.[1] published a single-institution retrospective chart review whose objective was to identify predictors of 30 day readmission after inpatient ERCP. Of a total of 497 inpatient ERCPs performed over a 46-month period, 52 (10.5%) were readmitted within 30 days after hospital discharge. Although basic demographic characteristics were similar between those readmitted vs those not, comorbidities were significantly higher in those readmitted. By multivariate analysis, cirrhosis or a history of prior liver transplantation significantly increased the odds for readmission. Placement of a pancreatic duct stent was also associated with increased odds of readmission, though this association is limited to patients with acute or chronic pancreatitis undergoing ERCP for pancreatic endotherapy since twenty percent of those patients were readmitted. In patients who had an ERCP and pancreatic stent placement for a biliary indication, the association with readmission was no longer present. In a subgroup analysis for patients having ERCP for biliary indications, early ERCP (within 3 days of admission) and cholecystectomy prior to discharge were associated with decreased need for readmission.The 30-day readmission metric as a quality indicator is of limited utility, as only a small proportion of readmissions are likely to be preventable [2]. For instance, in this study, more than half of the readmissions were unrelated to pancreaticobiliary indications and were presumably not directly related to the prior ERCP. Nevertheless, for readmissions that were for pancreaticobiliary-related conditions, almost half (11/25) were related to gallbladder or biliary stones that may have been prevented if a cholecystectomy had been performed prior to discharge. As such, the authors conclude that appropriate surgical management, including performing a cholecystectomy prior to discharge where indicated, should be accomplished, in keeping with previous studies supporting cholecystectomy during the index admission rather than after discharge in order to diminish readmission rates for pancreaticobiliary complications [3,4]. Chronic pancreatitis is associated with frequent readmissions with as many as one in four patients readmitted within 30 days [5] which likely accounts in part for the increased odds of readmission in this study for the subgroup of patients that had a pancreatic stent placed for pancreatic endotherapy. Similarly, liver transplant patients and cirrhotics have high readmission rates due to underlying disease regardless of whether they have had an ERCP [6].The majority of readmissions in patients who have had an inpatient ERCP may not be preventable as they are either unrelated to pancreaticobiliary complications or are associated with...

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supporting

confidence: 69%

supporting

confidence: 69%

Concise Commentary: A Stitch in Time—Prophylactic Cholecystectomy Can Reduce Readmission After ERCP

Gordon

2020

Dig Dis Sci

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“…17 studies were based in high-income settings including USA (n = 12) [ 24 , 27 , 29 – 37 , 39 ], UK (n = 4) [ 17 , 21 , 25 , 40 ] and Germany (n = 1) [ 38 ], while three studies were based in low-to-middle income countries including Mexico [ 26 ], Iran [ 28 ], and China [ 41 ]. All studies employed cross-sectional or observational study designs, including prospective cohort, retrospective and longitudinal observational studies.…”

Section: Resultsmentioning

confidence: 99%

Depression and unplanned secondary healthcare use in patients with multimorbidity: A systematic review

et al. 2022

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Background Growing numbers of people with multimorbidity have a co-occurring mental health condition such as depression. Co-occurring depression is associated with poor patient outcomes and increased healthcare costs including unplanned use of secondary healthcare which may be avoidable. Aim To summarise the current evidence on the association between depression and unplanned secondary healthcare use among patients with multimorbidity. Methods We conducted a systematic review by searching MEDLINE, EMBASE, PsychINFO, Web of Science, CINAHL, and Cochrane Library from January 2000 to March 2021. We included studies on adults with depression and at least one other physical long-term condition that examined risk of emergency hospital admissions as a primary outcome, alongside emergency department visits or emergency readmissions. Studies were assessed for risk of bias using The National Institute of Health National Heart, Lung, and Blood Institute quality assessment tool. Relevant data were extracted from studies and a narrative synthesis of findings produced. Results Twenty observational studies were included in the review. Depression was significantly associated with different outcomes of unplanned secondary healthcare use, across various comorbidities. Among the studies examining these outcomes, depression predicted emergency department visits in 7 out of 9 studies; emergency hospital admissions in 19 out of 20 studies; and emergency readmissions in 4 out of 4 studies. This effect increased with greater severity of depression. Other predictors of unplanned secondary care reported include increased age, being female, and presence of greater numbers of comorbidities. Conclusion Depression predicted increased risk of unplanned secondary healthcare use in individuals with multimorbidity. The literature indicates a research gap in identifying and understanding the impact of complex multimorbidity combinations, and other patient characteristics on unplanned care in patients with depression. Findings indicate the need to improve planned care for patients with moderate-to-severe depression. We suggest regular reviews of care plans, depression severity monitoring and assessment of hospital admission risk in primary care settings.

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“… 71 , 72 Male sex is independently associated with requiring hospital readmission among patients with CP. 73 Older men are at increased risk of exocrine pancreatic insufficiency compared with older women. 74 Men are more likely to transition from acute to CP than women.…”

Section: Chronic Pancreatitismentioning

confidence: 99%

Sex Differences in the Exocrine Pancreas and Associated Diseases

Wang

Gorelick

Bhargava

2021

Cellular and Molecular Gastroenterology and Hepatology

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Differences in pancreatic anatomy, size, and function exist in men and women. The anatomical differences could contribute to the increase in complications associated with pancreatic surgery in women. Although diagnostic criteria for pancreatitis are the same in men and women, major sex differences in etiology are reported. Alcohol and tobacco predominate in men, whereas idiopathic and obstructive etiologies predominate in women. Circulating levels of estrogens, progesterone, and androgens contribute significantly to overall health outcomes; premenopausal women have lower prevalence of cardiovascular and pancreatic diseases suggesting protective effects of estrogens, whereas androgens promote growth of normal and cancerous cells. Sex chromosomes and gonadal and nongonadal hormones together determine an individual’s sex, which is distinct from gender or gender identity. Human pancreatic disease etiology, outcomes, and sex-specific mechanisms are largely unknown. In rodents of both sexes, glucocorticoids and estrogens from the adrenal glands influence pancreatic secretion and acinar cell zymogen granule numbers. Lack of corticotropin-releasing factor receptor 2 function, a G protein–coupled receptor whose expression is regulated by both estrogens and glucocorticoids, causes sex-specific changes in pancreatic histopathology, zymogen granule numbers, and endoplasmic reticulum ultrastructure changes in acute pancreatitis model. Here, we review existing literature on sex differences in the normal exocrine pancreas and mechanisms that operate at homeostasis and diseased states in both sexes. Finally, we review pregnancy-related pancreatic diseases and discuss the effects of sex differences on proposed treatments in pancreatic disease.

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Incidence and predictors of 30-day readmissions in patients hospitalized with chronic pancreatitis: A nationwide analysis

Cited by 29 publications

References 29 publications

Concise Commentary: A Stitch in Time—Prophylactic Cholecystectomy Can Reduce Readmission After ERCP

Concise Commentary: A Stitch in Time—Prophylactic Cholecystectomy Can Reduce Readmission After ERCP

Depression and unplanned secondary healthcare use in patients with multimorbidity: A systematic review

Sex Differences in the Exocrine Pancreas and Associated Diseases

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