Elevated BISAP Score, Age, Tube-feeds, and Charlson Comorbidity Index (CCI) are Associated with Early Unplanned Readmission in Acute Pancreatitis (AP)

Abstract

Purpose: Early unplanned readmission (re-hospitalization or evaluation in the ED within 30 days after discharge) has important healthcare economic implications. The aim was to identify risk factors for early unplanned readmission in patients with mild first-time AP. Methods: This retrospective study included consecutive patients presenting with first-time AP to a single large tertiary referral center between 2007 and 2012. Patients with pancreatic necrosis and severe AP were excluded. Demographic, clinical, radiographic and laboratory data were manually collected. The CCI is a validated scoring tool that predicts prognosis from baseline comorbid conditions, and was calculated for all patients. Logistic regression was performed to assess the impact of predictor variables on the outcome of early readmission. Results: Of 222 total patients, 30 (14%) were readmitted within 30 days. Reasons for readmission included recurrent AP (6), abdominal pain (17), nausea (6), vomiting (6), and other symptoms (12). Older age, higher CCI, elevated BISAP scores on day 1, day 2, and day 3 (score ≥2), and tube-feed diet at discharge were all associated with early readmission in the univariable analysis [Table]. On multivariable analysis, the use of tube-feeds and elevated CCI remained independent risk factors for early-unplanned readmission.Table: Table. AP outcomesConclusion: Older age, presence of comorbidities, increased severity score, and use of tube feeds at discharge predicts early-unplanned readmission. Clinical Implication: Patients with these risk factors should be given close outpatient follow-up.