Biliary/Pancreas.

Abstract

Introduction: Between 11-19% of patients hospitalized for acute pancreatitis are re-admitted for pancreatitis related symptoms and complications. Our aim was to determine the role of a recently developed scoring system (Acute Pancreatitis Clinical Activity Index - AP-CAI) to recognize patients at high risk for re-admission. Methods: We evaluated consecutive patients hospitalized for acute pancreatitis at Los Angeles County Hospital from March 2015 and March 2016. Patients were excluded if they had chronic pancreatitis, died, or were transferred to another facility. Only a patient's first admission for pancreatitis (index hospitalization) in the study time period was included for analysis. We prospectively collected data on pain medications, oral diet tolerance, SIRS criteria, organ failure, and additional clinical variables. The dataset was reviewed by two individuals and the AP-CAI score at time of discharge was retrospectively calculated using this prospectively collected information (Table 1). The primary endpoint of the study, early readmission, was defined as inpatient re-hospitalization for pancreatits symptoms or complications within 30 days of discharge from the index hospitalization for AP.Table 1: The Acute Pancreatitis Clinical Activity Index (AP-CAI) Scoring SystemResults: Early readmission occurred in 29 (9%) of the 332 unique patients hospitalized for acute pancreatitis. Univariate analysis demonstrated that APCAI score >50 (OR 8.9: 95% CI [3.5, 22.7]) and history of prior acute pancreatitis admission (OR 3.2: 95% CI [1.4, 7.1]) predicted early hospital readmission. Among 115 patients with a discharge APCAI>50, 23 were readmitted (20.0%) versus 6(2.7%) of 217 with APCAI < 50 (p < 0.001). Thirty-nine additional variables including pancreatitis severity, origin, length of hospitalization, and Charlson comorbidity index were not significantly associated with early readmission. Multivariate analysis controlling for demographic variables, origin, pancreatitis severity, and prior acute pancreatitis confirmed that an APCA score >50 predicted readmission (OR 10.3 95% CI [3.7, 27.9])(Table 2). An additional 16 (5%) subjects were evaluated in the emergency department within 30 days for acute pancreatitis symptoms but were not readmitted. APCAI score greater than 50 also predicted emergency department re-evaluation (OR 9.2: 95% CI [2.6, 33.1]).Table 2: Predictors of ReadmissionConclusion: Acute Pancreatitis Clinical Activity Index - AP-CAI Score >50 at time of discharge is highly correlated with readmission within 30 days.