RESUMO
Background: Acute pancreatitis is a common inflammatory condition that involves the pancreas. Gallstones and alcohol are the most common etiologies in the USA. Cholecystectomy is the cornerstone procedure in the management of biliary acute pancreatitis (BAP). In this study, we examined the causes and predictors of readmissions following BAP based on the procedure performed. Methods: Using the Nationwide Readmissions Database (NRD) and the International Classification of Diseases, Tenth Revision, Clinical Modification/Procedure Coding System (ICD10-CM/PCS), we retrospectively studied BAP hospitalizations (2016 - 2018). The first hospitalization within the year was marked as index hospitalization. Index hospitalizations were categorized based on whether an endoscopic retrograde cholangiopancreatography (ERCP) and/or a cholecystectomy was performed into no procedure group, ERCP group, cholecystectomy group, and both procedures group. We subsequently identified readmissions within 30 days. Using this categorization, we studied reasons, rates, and predictors of readmissions. Results: A total of 127,318 index hospitalizations were included. The cholecystectomy group constituted the largest share of this cohort (43.5%). Using the no procedure group as a reference, analysis of the outcomes showed that the cholecystectomy group had the lowest inpatient mortality (adjusted odds ratio (aOR): 0.18, P < 0.001), while both procedures group had the highest total hospital charges (adjusted mean difference (aMD): 42,249, P < 0.001). Acute pancreatitis without necrosis or infection was the most frequent principal diagnosis for readmission (18.7%). Analysis of readmission predictors showed that both procedures group had the lowest risk for readmission (adjusted hazard ratio (aHR): 0.40, P < 0.001). Females were less likely to be readmitted compared to males (aHR: 0.82, P < 0.001) and elderly were less likely to be readmitted compared to young adults (aHR: 0.82, P < 0.001). Patients discharged against medical advice were more likely to be readmitted (aHR: 1.76, P < 0.001). Conclusion: Undergoing both ERCP and cholecystectomy for BAP resulted in significantly higher hospital charges with no additional mortality benefit. However, it decreased the readmission risk significantly. Acute pancreatitis without necrosis or infection was the most frequent reason for readmissions.
RESUMO
Background: Alcohol use disorder, high-risk drinking, and emergency visits for acute and chronic complications of alcohol use have been increasing in the USA recently. Approximately half of patients with alcohol use disorder experience alcohol withdrawal when they reduce or stop drinking. Though alcohol withdrawal is usually mild, 20% of patients experience more severe manifestations such as hallucinations, seizures, and delirium. In this study, we utilized the Nationwide Inpatient Sample to examine the trends of alcohol withdrawal delirium (AWD) in the period 2010 - 2019. Methods: This was a retrospective longitudinal trends study involving hospitalizations with AWD in the USA from 2010 to 2019. We searched the databases for hospitalizations using the International Classification of Diseases (ICD) codes (291.0 and F10231). We involved all hospitalizations complicated by AWD and hospitalizations with AWD as the principal diagnosis for admission. We excluded hospitalizations involving patients under the age of 18. We calculated the crude admission rate and the incidence of AWD per million adult hospitalizations during each calendar year. In addition, we analyzed trends of inpatient mortality, length of stay (LOS), and total hospital charges (THC). Results: The incidence of AWD per million hospitalizations increased from 2,671.8 in 2010 to 3,405.6 in 2019, with an annual percentage change (APC) of 3.1% (P < 0.001). Similarly, AWD admission rate per million hospitalizations increased from 1,030.3 in 2010 to 1,556.0 in 2019, with an average APC of 5.0% (P < 0.001). There were statistically significant trends of increasing inpatient mortality, THC, and LOS over the studied period. In general, female gender, younger age, and Black race were associated with better clinical outcomes. Conclusions: Our study showed an increase in the incidence and admission rates of AWD. Mortality, LOS, and THC increased over the studied period. Younger age, female gender, and Black race were associated with better clinical outcomes.
