S0059 Prevalence, Risks, Mortality, and Outcomes of Care Fragmentation During 30-Day and 90-Day Re-Admissions for Chronic Pancreatitis

Abstract

INTRODUCTION: BACKGROUND: Chronic pancreatitis (CP) is associated with high readmission rates, which may be to the same or a different hospital (care fragmentation). Care fragmentation is related to poor outcomes in patients with liver cirrhosis and inflammatory bowel disease. However, the healthcare burden of care fragmentation among CP remains unknown. AIMS: We aim to estimate the prevalence, trends, predictors, and burden of care fragmentation among readmissions for CP. METHODS: Among adult patients (age ≥18 years) surviving a hospitalization for CP in the Nationwide Readmissions Database (January–September 2010–2014), we calculated the annual prevalence, trends, and predictors (demographic, hospital and co-morbid) of care fragmentation during both short-term (30-days) and long-term (90-days) readmissions. While adjusting for covariates, we estimated the association between care fragmentation on mortality, duration of admission, and charges during both readmissions (SAS 9.4). RESULTS: There were 19,018 unique patients hospitalized for CP during the study period (2010–2014). Of these, 6,340 (28%) and 10,508 (46.3%) were readmitted in 30- and 90-days respectively. The rates of care fragmentation were similar (30-day: 28.7%; 90-day: 28.4%) among the readmitted patients, and were stable from 2010 to 2014 (P-trends >0.10, Figure 1). On multivariate analysis, the factors associated with higher odds of care fragmentation included younger age (18–45-years), hospital type (small bed-size, non-teaching, large metropolitan),and having gall-stone diseases (cholangitis, cholelithiasis and acute pancreatitis). During readmissions (30- and 90-day), care fragmentation was associated with higher mortality at 90-day readmission (Adjusted odds ratio: 1.69 [1.07–2.69], P-values < 0.0001), and higher hospital charges at 30- and 90-day readmission (Adjusted mean difference: $24,023 [95% CI: $7391–$77,907] & $15,686 [95% CI: $5,628–$43,550], P-values < 0.0001). Care fragmentation had no association with mortality at 30-day readmissions nor on duration of admission at both 30- and 90-day readmissions (Figure 2). CONCLUSION: Occurring in roughly 2 of 7 readmissions, Care fragmentation is prevalent among hospitalizations for CP at both 30- and 90-day readmissions. Given its association with higher mortality and hospital charges, measures to mitigate care fragmentation among patients with biliary diseases and young male patients in large non-teaching hospitals are needed to reduce these outcomes.Figure 1.: Annual trends in care fragmentation during readmissions after hospitalization for chronic pancreatitis.Figure 2.: Impact of Care Fragmentation on Outcomes of Readmissions for Chronic Pancreatitis.