ABSTRACT
BACKGROUNDS: Frequent hospitalization and the costs of hospitalization are the main burdens in China for patients with acute pancreatitis. Most admitted patients have mild disease conditions that do not require hospitalization. AIMS: Here, we compare some health and economic aspects of patients with mild acute pancreatitis who received nurse-led care at home visits against those who were hospitalized on follow-up. METHODS: Patients discharged from the hospital after treatment for mild acute pancreatitis received (NC cohort, n = 104) or did not receive (HN cohort, n = 141) regular home visits by nurses for treatment and care. Patients were rehospitalized by caregivers with or without help of nurse. RESULTS: Hospital readmission events occurred in both cohorts at a follow-up care time of 2 months. Compared with the time of discharge from the hospital, unwanted effects were higher in follow-up care in all patients (p < 0.001 for all). Patients in the NC cohort had less time to resolution of pain, less time to resumption of oral solid food intake, smaller number of patients with hospital readmissions, less average time of hospitalization, lower cost of care, and lower occurrence of unwanted effects than those of patients in the HN cohort during 2 months of follow-up care (p < 0.05 for all). CONCLUSIONS: Patients with mild acute pancreatitis who undergo treatment require nurse-led nontreatment intervention(s) for rehabilitation in follow-up. Nurse-led follow-up care at-home visits increase recovery, are beneficial and cost-effective, and decrease unwanted adverse effects in patients receiving treatment for mild acute pancreatitis. LEVEL OF EVIDENCE: IV. TECHNICAL EFFICACY: Stage 5.
Subject(s)
House Calls , Pancreatitis , Patient Readmission , Humans , Male , Female , Pancreatitis/nursing , Pancreatitis/therapy , Pancreatitis/economics , Retrospective Studies , Middle Aged , Adult , Patient Readmission/statistics & numerical data , House Calls/economics , China/epidemiology , Acute Disease , Severity of Illness Index , HospitalizationABSTRACT
Background: Acute pancreatitis (AP) is a common disease. There is no information available on the costs of treatment in Chile. Aim: To obtain information on the cost of hospitalization for AP and identify the factors that influence the account, to analyze health insurance coverage and the economic charge for the patient. Patients and Method: Retrospective and descriptive study. Patients treated at the Hospital Clínico Universidad de Chile with diagnosis of AP between May 1, 2014 and April 30, 2016 were included. The clinical records were reviewed after the patient's discharge. Demographic characteristics, clinical evolution, the account issued, the insurance payment and patient's copayment were registered. Results: In the period studied, 176 patients (90 women) were discharged with diagnosis of AP. The dominant etiology was biliary in 61%. According to the Atlanta 2013 classification, 78.4% of the cases were mild, 10.2% moderate, and 11.4% severe. 3 patients (1.7%) died. The median cost in Chilean pesos was $ 2,537,918 (1,383,151-3,897,673) (p25-75). The total sum of the accounts of 176 patients was $ 885,261,241, with an average of $ 5,029,893. The average coverage of the health system (FONASA or ISAPRE) was $ 4,293,113, leaving a copayment of $ 801,661. The final cost was related to the severity of the disease, the length of hospitalization and the need for a high-complexity bed. Discussion: Hospitalization costs for PA are high. It is advisable to rationalize the critical care bed indication.
Introducción: La pancreatitis aguda (PA) es una patología frecuente. No hay información disponible del costo de su tratamiento en Chile. Objetivo: Obtener información del costo de hospitalización por PA, identificar los factores que influyen en la cuenta, estudiar la cobertura por seguros de salud y el cargo económico para el paciente. Pacientes y Métodos: Estudio retrospectivo, descriptivo. Se incluyeron pacientes tratados en el Hospital Clínico Universidad de Chile con diagnóstico de PA entre 01 de mayo de 2014 y 30 de abril de 2016. Las fichas clínicas fueron revisadas después del alta del paciente, se registraron sus características demográficas, evolución clínica, la cuenta emitida, el pago del seguro y el copago del paciente. Resultados: En el periodo estudiado 176 pacientes (90 mujeres) fueron dados de alta con diagnóstico de PA. La etiología dominante fue biliar en 61% . Según la clasificación de Atlanta 2013, 78,4% de los casos fueron leves, 10,2% moderados y 11,4% severos. Fallecieron 3 pacientes (1,7%). La mediana de costos fue de $2.537.918 (1.383.151-3.897.673) (p25-75). La suma total de las cuentas de 176 pacientes fue de $ 885.261.241, con un promedio de $ 5.029.893. La cobertura promedio del sistema de salud (FONASA o ISAPRE) fue de $ 4.293.113 dejando un copago de $ 801.661. El costo final se correlacionó con la severidad de la enfermedad, la duración de la hospitalización y la necesidad de cama de alta complejidad. Discusión: Los costos de hospitalización por PA son elevados. Es recomendable racionalizar la indicación de cama crítica.
Subject(s)
Humans , Male , Female , Pancreatitis/economics , Health Care Costs , Hospitalization/economics , Pancreatitis/etiology , Pancreatitis/epidemiology , Severity of Illness Index , Chile , Acute Disease , Retrospective Studies , Insurance Coverage , Hospitals, UniversitySubject(s)
Health Care Costs/trends , Health Resources/economics , Health Resources/trends , Pancreatitis/economics , Pancreatitis/therapy , Patient Acceptance of Health Care , Digestive System Surgical Procedures/economics , Digestive System Surgical Procedures/trends , Endoscopy, Gastrointestinal/economics , Endoscopy, Gastrointestinal/trends , Health Expenditures/trends , Hospital Costs/trends , Humans , Incidence , North America/epidemiology , Pancreatitis/diagnosis , Pancreatitis/epidemiology , Pancreatitis, Chronic/diagnosis , Pancreatitis, Chronic/economics , Pancreatitis, Chronic/epidemiology , Pancreatitis, Chronic/therapy , Patient Readmission/economics , Patient Readmission/trends , Prevalence , Time FactorsABSTRACT
BACKGROUND: The Gallstone Pancreatitis: Admission vs Normal Cholecystectomy (Gallstone PANC) Trial demonstrated that cholecystectomy within 24 hours of admission (early) compared with after clinical resolution (control) for mild gallstone pancreatitis, significantly reduced 30-day length-of-stay (LOS) without increasing major postoperative complications. We assessed whether early cholecystectomy decreased 90-day healthcare use and costs. STUDY DESIGN: A secondary economic evaluation of the Gallstone PANC Trial was performed from the healthcare system perspective. Costs for index admissions and all gallstone pancreatitis-related care 90 days post-discharge were obtained from the hospital accounting system and inflated to 2020 USD. Negative binomial regression models and generalized linear models with log-link and gamma distribution, adjusting for randomization strata, were used. Bayesian analysis with neutral prior was used to estimate the probability of cost reduction with early cholecystectomy. RESULTS: Of 98 randomized patients, 97 were included in the analyses. Baseline characteristics were similar in early (n = 49) and control (n = 48) groups. Early cholecystectomy resulted in a mean absolute difference in LOS of -0.96 days (95% CI, -1.91 to 0.00, p = 0.05). Ninety-day mean total costs were $14,974 (early) vs $16,190 (control) (cost ratio [CR], 0.92; 95% CI, 0.73-1.15, p = 0.47), with a mean absolute difference of $1,216 less (95% CI, -$4,782 to $2,349, p = 0.50) per patient in the early group. On Bayesian analysis, there was an 81% posterior probability that early cholecystectomy reduced 90-day total costs. CONCLUSION: In this single-center trial, early cholecystectomy for mild gallstone pancreatitis reduced 90-day LOS and had an 81% probability of reducing 90-day healthcare system costs.
Subject(s)
Cholecystectomy/statistics & numerical data , Gallstones/surgery , Pancreatitis/surgery , Postoperative Complications/epidemiology , Time-to-Treatment/statistics & numerical data , Adult , Cholecystectomy/adverse effects , Cholecystectomy/economics , Cost-Benefit Analysis , Female , Gallstones/complications , Gallstones/diagnosis , Gallstones/economics , Health Care Costs/statistics & numerical data , Humans , Length of Stay/economics , Length of Stay/statistics & numerical data , Male , Middle Aged , Pancreatitis/diagnosis , Pancreatitis/economics , Pancreatitis/etiology , Postoperative Complications/economics , Postoperative Complications/etiology , Severity of Illness Index , Time Factors , Time-to-Treatment/economicsABSTRACT
OBJECTIVES: Cannabis legalization has increased its use. The incidence of acute pancreatitis (AP) and severe acute pancreatitis (SAP) has also increased. In this study, data on pancreatitis were obtained from 2 states before and after cannabis legalization and compared with 2 states without legalized cannabis. METHODS: Data were extracted from State Inpatient Databases from the states of Colorado and Washington before recreational cannabis legalization (2011) and after legalization (2015). Arizona and Florida were used as the nonlegalized cannabis states. Multivariable logistic regression models were fit for AP and SAP to determine a trend difference between legalized and nonlegalized cannabis states. RESULTS: Cannabis use, AP, and SAP increased in all states. The increase in AP and SAP was not significantly different between the states that legalized cannabis use and those that did not. Legalized cannabis states had lower charges for AP and SAP and shorter length of hospitalizations. CONCLUSIONS: The trend of AP and SAP increased during the study period, but this was not correlated to cannabis use. Cannabis users had lower hospitalization costs and hospital stay. The effects of other confounders such as cannabis dose and delivery methods, alcohol, tobacco, and others need to be studied further as use increases.
Subject(s)
Cannabis/adverse effects , Marijuana Smoking/adverse effects , Pancreatitis/epidemiology , Recreational Drug Use , Adolescent , Adult , Aged , Databases, Factual , Female , Government Regulation , Hospital Costs , Humans , Incidence , Legislation, Drug , Length of Stay , Male , Marijuana Smoking/legislation & jurisprudence , Marijuana Smoking/trends , Middle Aged , Pancreatitis/diagnosis , Pancreatitis/economics , Pancreatitis/therapy , Recreational Drug Use/legislation & jurisprudence , Recreational Drug Use/trends , Risk Assessment , Risk Factors , Severity of Illness Index , State Government , Time Factors , United States/epidemiology , Young AdultABSTRACT
OBJECTIVES: This retrospective cohort study assessed short- and long-term economic, clinical burden, and productivity impacts of acute pancreatitis (AP) in the United States. METHODS: United States claims data from patients hospitalized for AP (January 1, 2011-September-30, 2016) were sourced from MarketScan databases. Patients were categorized by index AP severity: severe intensive care unit (ICU), severe non-ICU, and other hospitalized patients. RESULTS: During index, 41,946 patients were hospitalized or visited an emergency department for AP. For inpatients, median (interquartile range) AP-related total cost was $13,187 ($12,822) and increased with AP severity (P < 0.0001). During the postindex year, median AP-related costs were higher (P < 0.0001) for severe ICU versus severe non-ICU and other hospitalized patients. Hours lost and costs due to absence and short-term disability were similar between categories. Long-term disability costs were higher (P = 0.005) for severe ICU versus other hospitalized patients. Factors associated with higher total all-cause costs in the year after discharge included AP severity, length of hospitalization, readmission, AP reoccurrence, progression to chronic pancreatitis, or new-onset diabetes (P < 0.0001). CONCLUSIONS: An AP event exerts substantial burden during hospitalization and involves long-term clinical and economic consequences, including loss of productivity, which increase with index AP event severity.
Subject(s)
Cost of Illness , Emergency Service, Hospital/economics , Hospitalization/economics , Intensive Care Units/economics , Length of Stay/economics , Pancreatitis/economics , Acute Disease , Delivery of Health Care/economics , Delivery of Health Care/statistics & numerical data , Health Care Costs/statistics & numerical data , Humans , Pancreatitis/diagnosis , Pancreatitis/therapy , Patient Discharge/statistics & numerical data , Retrospective Studies , Severity of Illness Index , Time Factors , United StatesABSTRACT
BACKGROUND: Compared to general population, human immunodeficiency virus (HIV) infection may increase frequency of acute pancreatitis (AP); however, evidence regarding effects of HIV infection on AP-related outcomes is limited and controversial. AIMS: We aim to investigate the temporary trend, characteristics and clinical outcomes of AP infected with HIV. METHODS: We reviewed data from the 2003-2014 National Inpatient Sample to identify patients with a primary diagnosis of AP. The primary outcomes (in-hospital mortality, acute respiratory failure, acute kidney injury, and prolonged length of stay [LOS]) and secondary outcomes (gastrointestinal hemorrhage, sepsis and total cost) were compared between patients with and without HIV infection using univariate, multivariable and propensity score matching analyses. RESULTS: Of 594,106 patients diagnosed with AP, 6775 (1.14%) had HIV infection. Patients with HIV were more likely to be younger, black, male, less likely to be gallstone-related and had lower rate of interventions. Multivariable analyses based on multiple imputation revealed that HIV infection was associated with higher risk of mortality (odds ratio [OR]: 1.74; 95% confidence interval [CI] 1.34-2.25), acute kidney injury (OR: 1.13; 95% CI 1.19-1.44), prolonged LOS (OR: 1.26; 95% CI 1.15-1.37) and 6% higher cost. There were no differences in sepsis, gastrointestinal bleeding, and respiratory failure between groups. CONCLUSIONS: HIV infection is associated with adverse outcomes including increased mortality, acute kidney injury and more healthcare utilization in AP patients. More assertive management strategies like early intravenous fluid resuscitation in HIV patients hospitalized with AP to prevent acute kidney injury may be helpful to improve clinical outcomes.
Subject(s)
HIV Infections/epidemiology , Pancreatitis/therapy , Acute Kidney Injury/epidemiology , Adult , Aged , Databases, Factual , Female , HIV Infections/diagnosis , HIV Infections/economics , HIV Infections/mortality , Hospital Costs , Hospital Mortality , Humans , Inpatients , Length of Stay , Male , Middle Aged , Pancreatitis/diagnosis , Pancreatitis/economics , Pancreatitis/mortality , Risk Assessment , Risk Factors , Time Factors , Treatment Outcome , United States/epidemiologyABSTRACT
OBJECTIVES: Acute pancreatitis (AP) guidelines for adult patients do not recommend routine prophylactic use of antibiotics because of no clinical merit on mortality, infectious complications, or length of stay. Although the mortality of pediatric AP is low, no studies have explored the rationale for antibiotic use in pediatric patients. The aim of this study was to evaluate the effects of early prophylactic antibiotics on length of stay and total costs in pediatric patients. METHODS: Using the Japanese Diagnosis Procedure Combination database from 2010 to 2017, we used the stabilized inverse probability of treatment weighting method using propensity scores to balance the background characteristics in the antibiotics group and the control group, and compared length of stay and total costs between the groups. RESULTS: We found significant differences between the antibiotics group (n = 652) and the control group (n = 467) in length of stay (11 days vs 9 days; percent difference, 15.4%; 95% confidence interval, 5.0%-26.8%) and total costs (US $4085 vs US $3648; percent difference, 19.8%; 95% confidence interval, 8.0%-32.9%). CONCLUSIONS: Prophylactic antibiotics were associated with longer length of stay and higher total costs. Our results do not support routine use of prophylactic antibiotics in pediatric AP populations.
Subject(s)
Antibiotic Prophylaxis/economics , Drug Costs , Hospital Costs , Length of Stay/economics , Pancreatitis/drug therapy , Pancreatitis/economics , Adolescent , Age Factors , Antibiotic Prophylaxis/adverse effects , Child , Cost-Benefit Analysis , Databases, Factual , Female , Humans , Japan , Male , Pancreatitis/diagnosis , Retrospective Studies , Time Factors , Treatment OutcomeABSTRACT
BACKGROUND: Controversy exists over the timing of cholecystectomy for biliary pancreatitis in children. Some surgeons await normalization of serum lipase levels while others are guided by resolution of abdominal pain; however, there are minimal data to support either practice. We hypothesized that resolution of abdominal pain is equivalent in outcome to awaiting normalization of lipase levels in patients undergoing cholecystectomy for biliary pancreatitis. METHODS: After institutional review board (IRB) approval, the medical record was retrospectively queried for all cases of cholecystectomy for biliary pancreatitis at our institution from 2007 to 2017. Patients undergoing chemotherapy, admitted for another cause, or who had severe underlying comorbidities like ventilator dependence were excluded. Patients were stratified into two cohorts: those managed preoperatively by normalization of serum lipase levels versus resolution of abdominal pain. Demographics, serum lipase levels, postoperative complications, cost of stay, readmissions, and return to the emergency department were collected and analyzed using multivariate regression. RESULTS: Seventy-four patients met inclusion: 29 patients had lipase levels trended until normalization compared with 45 patients who had resolution of abdominal pain prior to cholecystectomy. Among the two cohorts there was no statistical difference in age, gender, race, ethnicity, or type of preoperative imaging used. Trended patients were found to have more serum lipase levels tested (8.5 ± 6.2 versus 3.4 ± 2.5, P < 0.0001). The trended lipase cohort was significantly more likely to require preoperative total parenteral nutrition (48% versus 11%, P = 0.007) and consequently a longer time before resuming a diet (10 ± 7.3 versus 4.6 ± 2.4 d, P < 0.0001). When comparing the two groups, we found no significant difference in the duration of surgery, postoperative complications, or readmissions. Lipase trended patients had a significantly longer length of stay compared with nontrended patients (11.5 ± 8.1 versus 4.2 ± 2.3 d, P < 0.0001) and had a higher total cost of stay ($38,094 ± 25,910 versus $20,205 ± 5918, P = 0.0007). CONCLUSIONS: Our data suggest that in children with biliary pancreatitis, proceeding with cholecystectomy after resolution of abdominal pain is equivalent in outcomes to trending serum lipase levels but is more cost-effective with a decreased length of stay and decreased need for preoperative total parenteral nutrition.
Subject(s)
Abdominal Pain/diagnosis , Cholecystectomy, Laparoscopic/standards , Gallstones/complications , Lipase/blood , Pancreatitis/surgery , Time-to-Treatment/standards , Abdominal Pain/economics , Abdominal Pain/etiology , Abdominal Pain/therapy , Adolescent , Child , Cholecystectomy, Laparoscopic/adverse effects , Cholecystectomy, Laparoscopic/economics , Cholecystectomy, Laparoscopic/statistics & numerical data , Clinical Decision-Making/methods , Cost-Benefit Analysis/statistics & numerical data , Female , Gallstones/blood , Gallstones/economics , Gallstones/therapy , Humans , Length of Stay/economics , Length of Stay/statistics & numerical data , Male , Operative Time , Pain Measurement , Pancreatitis/blood , Pancreatitis/economics , Pancreatitis/etiology , Parenteral Nutrition, Total/statistics & numerical data , Patient Readmission/statistics & numerical data , Postoperative Complications/economics , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Practice Guidelines as Topic , Preoperative Care/economics , Preoperative Care/statistics & numerical data , Retrospective Studies , Time Factors , Time-to-Treatment/economics , Time-to-Treatment/statistics & numerical data , Treatment OutcomeABSTRACT
OBJECTIVE: The aim of the study was to evaluate lactated ringers (LR) versus normal saline (NS) in pediatric acute pancreatitis (AP). METHODS: This retrospective study used Pediatric Health Information System database of primary AP patients, 2013 to 2017. RESULTS: The study included 1581 first time AP patients with exclusive use of a single fluid (111 LR, 1470 NS) for the first 48 hours. The LR cohort had a significantly shorter length of stay (P < 0.001) compared with NS. A multivariable logistic regression analysis suggests use of NS in the first 48 hours (after controlling for total parenteral nutrition, operation, and infection during the admission) had a significantly increased likelihood of requiring a hospitalization for 4 days or more compared with the LR group (odds ratio, 3.31; 95% confidence interval, 1.95-5.62). The overall cost was significantly less in the LR group. There was no statistical difference observed in risk factors for AP, intensive care transfer, organ dysfunction, or mortality. CONCLUSIONS: This represents the first large data set analysis of LR versus NS in pediatric AP. The use of LR was associated with a shorter length of stay and reduced cost compared with NS. Future randomized trials will help determine the ideal fluid choice for pediatric AP.
Subject(s)
Fluid Therapy , Length of Stay , Pancreatitis/therapy , Ringer's Lactate/administration & dosage , Saline Solution/administration & dosage , Adolescent , Age Factors , Child , Cost Savings , Cost-Benefit Analysis , Databases, Factual , Female , Fluid Therapy/adverse effects , Fluid Therapy/economics , Hospital Costs , Humans , Male , Pancreatitis/diagnosis , Pancreatitis/economics , Retrospective Studies , Ringer's Lactate/adverse effects , Ringer's Lactate/economics , Saline Solution/adverse effects , Saline Solution/economics , Time Factors , Treatment Outcome , United StatesABSTRACT
OBJECTIVES: To determine adherence to Choosing Wisely recommendations for using serum lipase to diagnose acute pancreatitis rather than amylase, avoiding concurrent amylase/lipase testing and avoiding serial measurements after the first elevated test as both are ineffective for tracking disease course. METHODS: Deidentified laboratory data from four large health systems were analyzed to determine concurrent testing rates, serial testing rates, and provider-ordering patterns. RESULTS: While most providers adhered to recommendations with 58,693 lipase-only tests ordered and performed, 86% of amylase tests were performed concurrently with lipase. Ambulatory, inpatient, and emergency department settings revealed concurrent rates of 51%, 41%, and 8%, respectively. Services with order sets containing both amylase and lipase were associated with higher rates of concurrent testing. CONCLUSIONS: Concurrent amylase/lipase testing is an area of opportunity to improve compliance, especially in ambulatory settings. Revision of order sets and provider education could be interventions to reduce unnecessary testing and save costs.
Subject(s)
Amylases/blood , Diagnostic Tests, Routine/economics , Health Care Costs , Lipase/blood , Pancreatitis/diagnosis , Biomarkers/blood , Humans , Pancreatitis/blood , Pancreatitis/economicsABSTRACT
PURPOSE: The purpose of the study is to investigate the course of acute pancreatitis in obese patients, the development of local and systemic complications and mortality rates. MATERIALS AND METHODS: We took and analyzed 482 histories of acute pancreatitis treated at Kyiv Regional Clinical Hospital from January 1, 2011 to February 2, 2019. The data were statistically processed in the Excel 2010 program using a descriptive method applying relative, absolute numbers, mean square deviations and their errors. A correlation between variables was studied using the Pearson's test (R2). The significance of the difference between the two independent groups was tested with Student's t-test. RESULTS: We included 482 patients in our study, i.e. 260 patients (54%) with obesity (the study group), and for comparison, 222 (46%) patients with normal body mass, constituting a control group. Obese patients had a higher mean age (55.4 ± 9.4 years, P = 0.01); also, they showed a statistically higher incidence of severe course of acute pancreatitis [85 (32.7%) vs. 16 (7.2%); P = 0.01*]. We noted an increase in the rate of acute pancreatitis with severe course in obese patients with mass gain (from 10.20% to 53.93%, P = 0.03*). Hospitalization time of obese patients was longer than in case of patients with normal body mass. In addition, we observed a two-fold longer hospitalization of obese patients at intensive care units (5.8 ± 0.8 vs. 2.7 ± 0.5 days, P = 0.01*). When investigating the mortality rate, we found out that the main cause of death was the progression of organ failure - 30 cases (6.3%), pulmonary embolism (TB) - 15 (3.1%) and DIC - 18 (3.7%). C onclusions: The presence of obesity in patients involves a high risk of severe acute pancreatitis. This risk increases with body mass increase. In addition, in obese patients the hospitalization and in-patient care takes longer, which increases the total cost of treatment and requires a cost-effective algorithm in the future. A high mortality rate in obese patients requires an improved treatment algorithm.
Subject(s)
Obesity/complications , Obesity/epidemiology , Pancreatitis/epidemiology , Pancreatitis/therapy , Acute Disease , Adult , Aged , Body Mass Index , Disease Progression , Female , Hospitalization/statistics & numerical data , Humans , Incidence , Male , Middle Aged , Obesity/therapy , Pancreatitis/economics , Pancreatitis/etiology , PrognosisABSTRACT
BACKGROUND AND AIMS: The revised Atlanta classification is widely used for the evaluation of acute pancreatitis (AP) severity. However, this classification cannot be used within 48 hours of AP onset. The aim of this study was to investigate the predictive factors of mortality in patients with AP on admission. METHODS: We evaluated the association between AP mortality and clinical parameters at the time of admission in patients with AP from April 2013 to December 2017 at one university hospital and one tertiary care referral center. RESULTS: A total of 203 consecutive patients were enrolled. Nine patients (4.4%) died despite multidisciplinary treatment. In a multivariable analysis, hematocrit ≥ 40% (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.01-1.13; P = 0.021), blood urea nitrogen (BUN) ≥ 40 mg/dL (OR, 1.26; 95% CI, 1.11-1.42; P < 0.001), base excess < -3.0 mmol/L (OR, 1.15; 95% CI, 1.04-1.26; P = 0.004), and inflammation extending to the rectovesical excavation (OR, 1.19; 95% CI, 1.10-1.30; P < 0.001) on admission were significantly associated with mortality. CONCLUSION: Among the imaging findings, inflammation extending to the rectovesical excavation was the only independent predictive factor for mortality in AP. This simple finding, obtained on computed tomography without contrast agent on admission, might be a promising prognostic factor for AP.
Subject(s)
Hospitalization , Pancreatitis/mortality , Adult , Aged , Aged, 80 and over , Female , Humans , Inflammation/complications , Inflammation/pathology , Male , Middle Aged , Pancreatitis/complications , Pancreatitis/diagnostic imaging , Pancreatitis/economics , Predictive Value of Tests , Severity of Illness Index , Treatment Outcome , Young AdultABSTRACT
BACKGROUND: Differentiating infection from inflammation in acute pancreatitis is difficult, leading to overuse of antibiotics. Procalcitonin (PCT) measurement is a means of distinguishing infection from inflammation as levels rise rapidly in response to a pro-inflammatory stimulus of bacterial origin and normally fall after successful treatment. Algorithms based on PCT measurement can differentiate bacterial sepsis from a systemic inflammatory response. The PROCalcitonin-based algorithm for antibiotic use in Acute Pancreatitis (PROCAP) trial tests the hypothesis that a PCT-based algorithm to guide initiation, continuation and discontinuation of antibiotics will lead to reduced antibiotic use in patients with acute pancreatitis and without an adverse effect on outcome. METHODS: This is a single-centre, randomised, controlled, single-blind, two-arm pragmatic clinical and cost-effectiveness trial. Patients with a clinical diagnosis of acute pancreatitis will be allocated on a 1:1 basis to intervention or standard care. Intervention will involve the use of a PCT-based algorithm to guide antibiotic use. The primary outcome measure will be the binary outcome of antibiotic use during index admission. Secondary outcome measures include: safety non-inferiority endpoint all-cause mortality; days of antibiotic use; clinical infections; new isolates of multiresistant bacteria; duration of inpatient stay; episode-related mortality and cause; quality of life (EuroQol EQ-5D); and cost analysis. A 20% absolute change in antibiotic use would be a clinically important difference. A study with 80% power and 5% significance (two-sided) would require 97 patients in each arm (194 patients in total): the study will aim to recruit 200 patients. Analysis will follow intention-to-treat principles. DISCUSSION: When complete, PROCAP will be the largest randomised trial of the use of a PCT algorithm to guide initiation, continuation and cessation of antibiotics in acute pancreatitis. PROCAP is the only randomised trial to date to compare standard care of acute pancreatitis as defined by the International Association of Pancreatology/American Pancreatic Association guidelines to patients having standard care but with all antibiotic prescribing decisions based on PCT measurement. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number, ISRCTN50584992. Registered on 7 February 2018.
Subject(s)
Algorithms , Anti-Bacterial Agents/therapeutic use , Decision Support Techniques , Drug Monitoring/methods , Pancreatitis/drug therapy , Procalcitonin/blood , Anti-Bacterial Agents/adverse effects , Anti-Bacterial Agents/economics , Biomarkers/blood , Clinical Decision-Making , Clinical Trials, Phase III as Topic , Cost Savings , Cost-Benefit Analysis , Drug Costs , Drug Monitoring/economics , England , Humans , Pancreatitis/blood , Pancreatitis/diagnosis , Pancreatitis/economics , Pragmatic Clinical Trials as Topic , Predictive Value of Tests , Single-Blind Method , Time Factors , Treatment OutcomeABSTRACT
OBJECTIVES: We sought to examine temporal trends in incidence and outcomes of acute pancreatitis (AP) in hospitalized adult patients in the United States. METHODS: Subjects were obtained from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample database using International Classification of Diseases, Ninth Revision, Clinical Modification codes for the years 2002-2013. Incidence of AP, all-cause mortality, cost, and duration of hospitalization were assessed. RESULTS: We identified 4,791,802 cases of AP. A significant increase in the incidence of AP was observed from 9.48 cases per 1000 hospitalizations in 2002 to 12.19 per 1000 hospitalizations in 2013 (P < 0.001). In-hospital mortality decreased from 2.99 cases per 100 cases in 2002 to 2.04 cases per 100 cases in 2013 (P < 0.001). Mean length of stay decreased from 6.99 (standard deviation [SD], 9.37) days in 2002 to 5.74 (SD, 7.94) days in 2013 (P < 0.001). Cost of hospitalization increased from $27,827 (SD, $54,556) in 2002 to $49,772 (SD, $106,205) in 2013 (P < 0.001). CONCLUSIONS: Hospital admissions for AP in adults increased significantly in the United States from 2002 to 2013. In-hospital all-cause mortality and mean length of stay significantly decreased. In contrast, total cost of hospitalization rose.
Subject(s)
Hospitalization/trends , Inpatients , Pancreatitis/epidemiology , Pancreatitis/therapy , Acute Disease , Adult , Aged , Databases, Factual , Female , Hospital Costs/trends , Hospital Mortality/trends , Hospitalization/economics , Humans , Incidence , Length of Stay/trends , Male , Middle Aged , Pancreatitis/economics , Pancreatitis/mortality , Registries , Risk Factors , Time Factors , Treatment Outcome , United States/epidemiologyABSTRACT
INTRODUCTION: Acute pancreatitis (AP) is the most common gastroenterology-related reason for hospital admission, and a major source of morbidity and mortality in the United States. This study examines the National Emergency Database Sample, a large national database, to analyze trends in emergency department (ED) utilization and costs, risk factors for hospital admission, and associated hospital costs and length of stay (LOS) in patients presenting with AP. METHODS: The National Emergency Database Sample (2006 to 2012) was evaluated for trends in ED visits, ED charges, hospitalization rates, hospital charges, and hospital LOS in patients with primary diagnosis of AP (further subcategorized by age and etiology). A survey logistic-regression model was used to determine factors predictive of hospitalization. RESULTS: A total of 2,193,830 ED visits were analyzed. There was a nonsignificant 5.5% (P=0.07) increase in incidence of ED visits for AP per 10,000 US adults from 2006 to 2012, largely driven by significant increases in ED visits for AP in the 18 to <45 age group (+9.2%; P=0.025), AP associated with alcohol (+15.9%; P=0.001), and AP associated with chronic pancreatitis (+59.5%; P=0.002). Visits for patients aged ≥65 decreased over the time period. Rates of admission and LOS decreased during the time period, while ED and inpatient costs increased (62.1%; P<0.001 and 7.9%; P=0.0011, respectively). Multiple factors were associated with increased risk of hospital admission from the ED, with the strongest predictors being morbid alcohol use [odds ratio (OR), 4.53; P<0.0001], advanced age (age>84 OR, 3.52; P<0.0001), and smoking (OR, 1.75; P<0.0001). CONCLUSIONS: Despite a relative stabilization in the overall incidence of ED visits for AP, continued increases in ED visits and associated costs appear to be driven by younger patients with alcohol-associated and acute on chronic pancreatitis. While rates of hospitalization and LOS are decreasing, associated inflation-adjusted costs are rising. In addition, identified risk factors for hospitalization, such as obesity, alcohol use, and increased age, should be explored in further study for potential use in predictive models and clinical improvement projects.
Subject(s)
Pancreatitis/epidemiology , Patient Admission/statistics & numerical data , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Databases, Factual , Emergency Service, Hospital , Female , Health Care Costs , Humans , Incidence , Length of Stay , Male , Middle Aged , Pancreatitis/economics , Pancreatitis/etiology , United States/epidemiology , Young AdultABSTRACT
OBJECTIVE: Pediatric acute pancreatitis (AP) may be different from adult AP in various respects. This study focuses on the epidemiology and medical resource use of pediatric AP in Taiwan. METHODS: Patients aged 0 to 18 years with AP were identified from the Taiwan National Health Insurance Research Database based on the International Classification of Diseases, Ninth Revision code of AP 577.0. The medical resource use was measured by length of hospital stay and hospital charges. RESULTS: Between 2000 and 2013, a total of 2127 inpatient cases of pediatric AP were collected, which represented a hospitalization rate of 2.83 per 100,000 population. The incidence by age had 2 peaks, the first peak was at age 4 to 5 years old, and the second one started rising from 12 to 13 years old until adulthood. The incidence by year increased from 2.33 to 3.07 cases per 100,000 population during the study period. The average hospital stay is steady, but the medical cost is increasing. Girls have longer hospital stays, higher medical expenditures, more use of endoscopic retrograde cholangiopancreatography possibly due to more comorbidities with biliary tract diseases than boys (Pâ<â0.05). The mortality in cases of AP is mostly associated with systemic diseases rather than AP itself. CONCLUSIONS: The incidence of pediatric AP in Taiwan is in a rising trend. There are gender differences in length of hospital stay, medical costs, use of endoscopic retrograde cholangiopancreatography and comorbidities.
Subject(s)
Pancreatitis/epidemiology , Acute Disease , Adolescent , Child , Child, Preschool , Cholangiopancreatography, Endoscopic Retrograde/statistics & numerical data , Databases, Factual , Female , Hospital Charges/statistics & numerical data , Humans , Incidence , Infant , Infant, Newborn , Length of Stay/statistics & numerical data , Male , Pancreatitis/economics , Risk Factors , Sex Factors , Taiwan/epidemiologyABSTRACT
AIM: Acute pancreatitis is associated with significant morbidity and mortality. In the United States, more than 3,00,000 patients are admitted and about 20,000 die from acute pancreatitis per year. In Taiwan, the incidence rate of acute pancreatitis is 0.03% and the mortality rate among severe acute pancreatitis is 16.3%. The aim of the study was to evaluate the impact of the global budgeting system on health service utilization, health care expenditures, and quality of care among patients with acute pancreatitis in Taiwan. MATERIALS AND METHODS: The National Health Insurance Research Database (NHIRD) was used for analysis. Data on patients with acute pancreatitis diagnosed during the period 2000 and 2001 were used as baseline data, and data from 2004 and 2005 were used as post-intervention data. The length of stay (LOS), diagnostic costs, drug cost, therapy costs, total costs, risk of readmission within 14 days, and risk of revisiting the emergency department (ED) within 3 days of discharge before and after implementation of the global budgeting system were compared and analyzed. RESULTS: Data on 2810 patients with acute pancreatitis were analyzed in this study. There was a significant difference in mean LOS before and after introduction of the global budget system (7.34â±â0.22 days and 7.82â±â0.22 days, respectively; Pâ<â.001)). The mean total costs before and after implementation of the global budget system were Taiwan dollars (NT$) 28,290.66â±â1576.32 and NT$ 42,341.83â±â2285.23, respectively. The mean rate of revisiting the ED within 3 days decreased from 9.9â±â0.9% before adoption of global budgeting to 7.2â±â0.6% after implementation of the system. The mean 14-day re-admission rates before and after introduction of global budgeting were 11.6â±â1.0% and 7.9â±â0.7%, respectively. CONCLUSION: The global budget system was associated with significantly longer length of stay, higher health care expenditures, and better quality of care in patients treated for acute pancreatitis.
Subject(s)
Budgets/statistics & numerical data , Health Expenditures/statistics & numerical data , Health Services/statistics & numerical data , Pancreatitis/economics , Quality of Health Care/statistics & numerical data , Budgets/methods , Comorbidity , Emergency Service, Hospital/statistics & numerical data , Female , Humans , Length of Stay/statistics & numerical data , Male , Middle Aged , National Health Programs/statistics & numerical data , Patient Readmission/statistics & numerical data , Socioeconomic Factors , TaiwanABSTRACT
BACKGROUND: Treatment of recurrent chronic obstructive pancreatitis is pancreatic duct decompression with endoscopic drainage (endoscopic pancreatic stenting [EPS] with extracorporeal shockwave lithotripsy [ESWL]) or surgical drainage. Despite the recent popularization of endoscopic drainage, treatment or stent removal is difficult in many patients. We compared the efficacy, safety, and medical cost of endoscopic and surgical treatments. PATIENTS AND METHODS: We retrospectively compared the treatment course and medical cost of hospitalization between 41 patients who had undergone pancreatic stenting between 2006 and 2010 (EPS group) and 10 patients who had undergone surgery for poor control of pancreatitis between 2001 and 2005 (surgical drainage group). RESULTS: No intergroup differences were observed in causes, symptoms, disease duration, smoking history, or endocrine and exocrine functions. The technical success rate was 100% in both groups, and pain had improved in all of the patients in both groups. The incidences of complications did not differ significantly, and the mortality rate was 0% in both groups. The rehospitalization rate was significantly higher in the EPS group (78%) than that in the surgical drainage group (20%; P<0.01). This was considered attributable to rehospitalization for stent replacement. The effects to improve endocrine and exocrine functions were not different between the two groups before and after treatment, and the current condition was maintained in 80% or more of the patients. For the entire EPS group, the mean hospitalization period was 18 days and the mean medical cost of hospitalization was 2,133,330 yen. For the entire surgical drainage group, the mean hospitalization period was 23 days and the mean medical cost of hospitalization was 2,246,548 yen, thus indicating no significant differences between the two groups. CONCLUSIONS: Although both endoscopic and surgical treatments achieved high symptom control and safety rates, re-hospitalization is required for stent replacement, which leads to poor cost-effectiveness, particularly in patients in whom stent removal is difficult. Endoscopic treatment for severe pancreatic duct stenosis will need to be advanced and evaluated in the future.