S109 Clinical Predictors of Ileus in Hospitalized Patients With Acute Pancreatitis: A Nationwide Analysis

Abstract

Introduction: Ileus is a well-known complication of acute pancreatitis (AP). Limited data exists on incidence or factors associated with ileus in patients with AP. We aimed to investigate the incidence and clinical predictors of ileus in hospitalized patients with AP. Methods: We queried the 2016-2019 National Inpatient Sample (NIS) database using the ICD-10 codes. All adult patients with a diagnosis of AP (ICD-10 K85) were included and those with chronic pancreatitis were excluded from the analysis. We studied demographics, comorbidities, complications, and interventions in patients with AP and stratified the results by the presence of ileus. Multivariate analysis was conducted to elucidate clinical factors associated with ileus formation in patients with acute pancreatitis. We adjusted for patient demographics, hospital characteristics, elixhauser comorbidities and common complications of pancreatitis. Results: Of the 1,386,389 adult patients admitted with AP, 50,170 (3.6%) developed ileus. Female gender was associated with a 44% lower risk of ileus (aOR- 0.56, 95% CI- 0.53-0.58, p< 0.001). Hispanic patients had the lowest risk of ileus (aOR- 0.82, 95% CI- 0.76-0.88, p< 0.001) while White patients had the highest risk. Patients between the age of 18-44 had a lower risk of ileus as compared to patients in the 45-64 (aOR-1.11, 95% CI- 1.05-1.17, p< 0.001) and >65 age group (aOR-1.14, 95% CI- 1.06-1.24, p< 0.001). Other factors associated with ileus include the presence of pseudocyst (aOR- 1.52, p< 0.001), sepsis (aOR-1.72, p< 0.001), and portal vein thrombosis (aOR-1.36, p< 0.001). ERCP was not associated with ileus development, however, pancreatic drainage was associated with a higher risk of ileus (aOR-1.21, p< 0.007). The results of the multivariate analysis are depicted in Table: Patients with ileus were also noted to have a statistically significant higher mortality (a0R-1.58, 95% CI- 1.43-1.75, p< 0.001), length of stay (+4.9 days, 95% CI- 4.63-5.12, p< 0.001), total hospitalization cost (+67,855.91, p< 0.001) and charges ($16,252.6, p< 0.001). Conclusion: This study highlights age, gender, and racial disparities in the development of ileus in patients with AP. It also reveals a significant association of ileus with pseudocyst, portal vein thrombosis, and pancreatic drainage. Timing of initiation of oral feeds is essential in patients with acute pancreatitis and ileus. Physicians should be aware of this high-risk group and consider early enteral feeding to prevent disease progression. Table 1. - Predictors of ileus in patients with acute pancreatitis. In this Table, we provide the results of multivariate logistic regression with odds ratio, p-value and 95% confidence interval Ileus Odds ratio p-value 95% Confidence interval Age category 18-44 Reference 45-64 1.11 < 0.001 1.05-1.17 >65 1.14 < 0.001 1.06-1.24 Sex Male Reference Female 0.56 < 0.001 0.54-0.59 Race White Reference African American 0.95 0.149 0.89-1.02 Hispanic 0.82 < 0.001 0.76-0.88 Asian/Pacific Islander 1.01 0.846 0.89-1.15 Native American 0.72 0.01 0.56-0.93 Primary expected payer Medicare Reference Medicaid 0.83 < 0.001 0.77-0.9 Private 1.11 < 0.001 1.04-1.18 Uninsured 0.8 < 0.001 0.72-0.88 Income quartile Lowest quartile Reference Second quartile 1.04 0.227 0.98-1.1 Third quartile 1.11 < 0.001 1.04-1.17 Highest quartile 1.14 < 0.001 1.07-1.22 Bed size of Hospital Small Reference Medium 1.04 0.224 0.98-1.11 Large 1.11 < 0.001 1.04-1.17 Region of hospital Northeast Reference Midwest 1.31 < 0.001 1.21-1.42 South 1.16 < 0.001 1.08-1.25 West 1.17 < 0.001 1.08-1.26 Location of hospital Rural hospitals Reference Urban hospitals 1.03 0.502 0.94-1.13 Teaching status of hospitals Non-teaching hospitals Reference Teaching Hospitals 1.05 0.084 0.99-1.1 Etiology of pancreatitis Biliary pancreatitis Reference Alcohol pancreatits 0.98 0.583 0.89-1.17 Biliary + alcohol pancreatitis 1.81 < 0.001 1.32-2.47 Other causes 0.88 < 0.001 0.84-0.93 Number of elixhauser comorbidities 0 Reference 1 1.26 < 0.001 1.11-1.43 2 1.41 < 0.001 1.24-1.6 3 or more 1.54 < 0.001 1.35-1.76 Comorbidities Cardiac arrhythmias 0.86 < 0.001 0.8-0.93 Congestive heart failure 1.26 < 0.001 1.19-1.33 Valvular disease 0.97 0.587 0.86-1.09 Pulmonary circulation disorders 0.96 0.558 0.85-1.09 Peripheral vascular disorders 0.95 0.279 0.87-1.04 Paralysis 1.32 0.009 1.07-1.62 Other neurological disorders 1.01 0.83 0.94-1.08 Chronic pulmonary disease 1.01 0.704 0.95-1.07 Chronic kidney disease 0.83 < 0.001 0.78-0.89 Liver disease 1.01 0.637 0.96-1.07 Metastatic solid tumor 0.84 0.036 0.72-0.99 Non-metastatic solid tumor 1.05 0.407 0.93-1.19 Rheumatoid arthritis/collagen vascular disorder 0.87 0.054 0.76-1 Coagulopathy 0.98 0.647 0.92-1.05 Malnutrition 1.32 < 0.001 1.24-1.41 Fluid/electrolyte disorders 1.59 < 0.001 1.51-1.67 Blood loss anemia 1.17 0.146 0.95-1.45 Deficiency Anemia 0.93 0.152 0.84-1.03 Alcohol abuse 0.73 < 0.001 0.68-0.78 Drug use 0.88 0.003 0.81-0.96 Psychosis 0.97 0.721 0.8-1.17 Depression 0.87 < 0.001 0.81-0.92 Diabetes 0.71 < 0.001 0.68-0.75 Hypertension 0.98 0.348 0.93-1.03 Complications Pneumonia 1.63 < 0.001 1.52-1.76 Bacteremia 0.97 0.787 0.76-1.23 Acute kidney injury 1.38 < 0.001 1.31-1.46 Portal vein thrombosis 1.41 < 0.001 1.2-1.66 Pseudocyst 1.57 < 0.001 1.44-1.72 Sepsis 1.75 < 0.001 1.63-1.89 Shock 1.18 < 0.001 1.08-1.29 ICU admission 1.99 < 0.001 1.83-2.17 Interventions TPN 4.22 < 0.001 3.84-4.64 ERCP 1.05 0.203 0.97-1.13 Pancreatic drainage 1.25 0.009 1.06-1.48