S0123 Early Unplanned Readmissions Following Same-Admission Cholecystectomy for Acute Biliary Pancreatitis

Abstract

INTRODUCTION: Patients with acute biliary pancreatitis (ABP) should undergo same-admission cholecystectomy (CCY) when indicated since it reduces the risk of 30-day readmission and recurrent acute pancreatitis. We sought to investigate the reasons and predictors for early-unplanned readmission following same-admission CCY for an index episode of ABP. METHODS: Using the Nationwide Readmission Database (2010–2014), we identified all adults (age ≥18 years) with a principle diagnosis of ABP who had undergone CCY during the index hospitalization. Patients with a diagnosis of chronic pancreatitis, pancreatic neoplasm, pregnancy, and those who died during index admission or were discharged in the month of December were excluded. Severe acute pancreatitis (severe-AP) was defined by the revised Atlanta classification. Multivariable logistic regression models were obtained to assess independent predictors for 30-day readmission. Principal diagnosis for all readmissions was collected to ascertain the key reasons for early readmission. RESULTS: During the study period, 118,224 patients underwent same-admission CCY for ABP. The rate of early (30-day) unplanned readmission was 7.25% (n = 8,574). Following multivariable analysis (Table 1), predictors for readmission included male gender (odds ratio [OR] 1.18, 95% confidence interval [CI] 1.08–1.28), insurance type (Medicare insurance [OR 1.26, 95% CI 1.13–1.40]; Medicaid [OR 1.22, 95% CI 1.09–1.38]), discharge other than home (OR 1.35, 95% CI 1.16–1.57), severe-AP (OR 1.35, 95% CI 1.21–1.50), and ≥3 Elixhauser comorbidities (OR 1.55, 95% CI 1.41–1.69). Variables associated with decreased risk of early readmission included performance of intraoperative cholangiogram (IOC) (OR 0.90, 95% CI 0.82–0.97), and ERCP (OR 0.81, 95% CI 0.73–0.89). Exacerbation of prior medical conditions, urinary tract infections, pneumonias, and C. Difficile infections accounted for 45% of early-unplanned readmissions (Table 2). Sequelae (i.e. pancreatic fluid collection) of or recurrent acute pancreatitis accounted for 34% and surgical complications due to CCY or uncontrolled postoperative symptoms accounted for 21% of the readmissions. CONCLUSION: This national appraisal recognizes modifiable risk factors, such as performing IOC and ERCP when indicated, and identifies preventable causes for early-unplanned readmissions following ABP with same-admission CCY.Table 1.: Multivariable logistic regression model for 30-day readmission among the population of patients with biliary AP who had a CCY on their index admission.Table 2.: Reasons for unplanned early (30-day) readmission after cholecystectomy for acute biliary pancreatitis: NRD 2010-2014.