S0042 Acute Biliary Pancreatitis Has Better In-Hospital Outcomes Compared to Acute Alcohol-Induced Pancreatitis: Results of a Nationwide Analysis

Abstract

INTRODUCTION: Acute pancreatitis (AP) is an acute inflammatory process involving the pancreas with considerable morbidity and mortality. The most common cause of AP is biliary disease followed by alcohol, accounting for estimated 70–80 percent of all cases of AP. Determination of the etiology may reliably guide immediate management of patient. METHODS: We queried the National Inpatient Sample (NIS) databases 2016 and 2017 using the International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) coding system to identify the following: (A) Patients with primary diagnosis of Acute Pancreatitis (AP) (B) Patients with a primary diagnosis of Acute Alcohol-induced Pancreatitis (AAP) and Acute Biliary Pancreatitis (ABP). Analysis was performed with STATA software. RESULTS: 553,480 adult patients who were diagnosed with AP during hospitalization in 2016 and 2017 were identified. Mean age was 51.8 years, and majority of patients were male (53.22%). 25.3% patients had AAP and 17.44% patients had ABP. Patients with ABP were more likely to be females compared to patients with AAP (59.4% vs 30.73%, P < 0.01), and were older (57.03 years vs 45.31 years, P < 0.01).The total mortality in patients with AAP was 0.42% and in patients with ABP was 0.82% with no significant difference on multivariate analysis (aOR: 0.95, 95% CI: 0.69–1.31, P = 0.79). Patients with ABP had a significantly longer Length of Stay (LOS) when compared with patients with APP (+0.48 days, P < 0.01). In addition, the ABP group had a significantly higher mean adjusted hospitalization charges and costs with a difference of $ +19,958 (P < 0.01) in charges and $+4,848 (P < 0.01) in cost. Patients with ABP had significantly lower likelihood of shock when compared to patients with AAP (aOR: 0.75, 95% CI: 0.59–0.95, P < 0.05). They were significantly less likely to develop AKI (aOR 0.76, 95% CI: 0.71-0.82, P < 0.01) or to be admitted to ICU (aOR 0.74, 95% CI: 0.62–0.88, P < 0.01). They were more likely to be discharged home (aOR 1.26, 95% CI: 1.18–1.34, P < 0.01). CONCLUSION: Our study showed no difference in mortality between patients with AAP and ABP. We found that patients with ABP had increased resource utilization. Patients with ABP are more likely to undergo invasive procedures like ERCP/cholecystectomy and this is likely the reason for increased resource use. Patients with ABP had significantly lower odds of AKI, shock and ICU stay. Further studies are needed to assess the reason for this difference and guide clinical practice.Figure 3.: Pooled rates of technical success, clinical success, and AE of POP, EHL and LL.