Thirty-Day Readmission Among Patients with Alcoholic Acute Pancreatitis.

BACKGROUND/OBJECTIVES: Alcoholic acute pancreatitis (AAP) comprises the second most common cause of acute pancreatitis in the USA, and there is lack of data regarding 30-day specific readmission causes and predictors. We aim to identify 30-day readmission rate, causes, and predictors of readmission. METHODS: Retrospective analysis of the 2016 National Readmission Database of adult patients readmitted within 30 days after an index admission for AAP. RESULTS: Totally, 76,609 AAP patients were discharged from the hospital in 2016. The 30-day readmission rate was 12%. The main cause of readmission was another episode of AAP. Readmission was not associated with higher mortality (1.3% vs. 1.2%; P = 0.21) or prolonged length of stay (5.2 vs. 5.0 days; P = 0.06). The total health care economic burden was $354 million in charges and $90 million in costs. Independent predictors of readmission were having Medicaid insurance, a Charlson comorbidity index score ≥ 3, use of total parenteral nutrition, opioid abuse disorder, prior pancreatic cyst, chronic alcoholic pancreatitis, and other chronic pancreatitis. Obesity was associated with lower odds of readmission. CONCLUSION: Readmission rate for AAP is high and its primary cause are recurrent episodes of AAP. Alcohol and substance abuse pose a high burden on our health care system. Public health strategies should be targeted to provide alcohol abuse disorder rehabilitation and cessation resources to alleviate the burden on readmission, the health care system and to improve patient outcomes.

Recent advances in the epidemiology of alcoholic pancreatitis.

Clinical observation has defined the medical profile of alcoholic pancreatitis, but its low incidence and prevalence has limited characterizing the disease at a population level, the contribution of environmental exposures, and a clear picture of its natural history. Recent studies have defined the impact of alcohol use and smoking on disease risk, and a threshold for alcohol consumption has been identified. Recurrent attacks of acute pancreatitis have been linked with continued alcohol consumption, and aggressive alcohol intervention has been shown to decrease recurrence. Progression from alcoholic acute pancreatitis to chronic pancreatitis is now believed to occur infrequently, and factors associated with progression have been identified. Alcoholic pancreatitis reduces lifespan in these patients, and the economic impact of pancreatitis is substantial. Efforts are needed to increase awareness of the impact of alcohol consumption and smoking on risk for pancreatitis and the benefits of cessation for primary and secondary prevention.

Economic impact of extracolonic findings at computed tomographic colonography.

OBJECTIVE: To determine the prevalence of extracolonic findings at computed tomographic colonography (CTC) and estimate the cost of the workup of newly discovered potentially significant lesions. SUBJECTS AND METHODS: An electronic information system was used to review all patient data before and after the CTC in a mixed cohort of 376 patients. Extracolonic findings were categorized into the CT Colonography Reporting and Data System classification. The impact of additional diagnostic workup was estimated using Medicare reimbursement for relevant extra services. RESULTS: There were 51 patients (13.6%) with E3 and 16 (4.3%) with E4 findings. At least 1 extracolonic finding was found in 272 patients (72.3%). There were 520 extracolonic findings, of which, 447 (86.0%) were classified as low clinical significance, E2. Only 7 (12.5%) of 56 E3 lesions and 7 (41.2%) of 17 E4 lesions received additional diagnostic workup. The total additional cost of evaluating E3 and E4 lesions was $13.07 per CTC. CONCLUSIONS: A mixed (screening and nonscreening) CTC population has a low prevalence of high-risk lesions, and the additional cost of their evaluation is relatively small.

Demographic characteristics of hospitalized patients with alcoholic liver disease and pancreatitis in los angeles county.

BACKGROUND: This study sought to identify demographic characteristics of hospitalized patients with alcoholic liver disease (ALD) in Los Angeles County for the purpose of implementing new preventive and educational programs. Another specific aim of the study was to characterize demographic and comorbid differences between patients with ALD and patients with pancreatitis, another alcohol-related disease. METHODS: Analyses were performed on discharge data from all nonfederal short-stay hospitals within Los Angeles County, released for the year 1999 by the Office of Statewide Health Planning and Development. Repeated hospital stays for ALD by the same patients were deleted from the data analysis based on individual identification numbers. For the analysis of medical costs of ALD, repeated hospital stays were included. RESULTS: Primary diagnosis of ALD accounted for 1.2% of total deaths among hospitalized patients and was the eighth most common cause of death among diseases examined. Moreover, the fatality rate of primary ALD among ALD hospital visits was the second highest, behind septicemia. ALD was most prevalent in the middle-aged (45-65 years old) and low- to middle-income men. The age-standardized hospitalization rate of ALD was highest in Hispanic men (61.1 per 100,000 per year), whereas that of chronic pancreatitis, another common complication of alcohol abuse, was most prevalent in African American men. CONCLUSIONS: Middle-aged Hispanic men with low- to middle-income status were identified as a high-risk group for ALD in Los Angeles County. These data will guide us to develop a new strategy for future preventative and educational programs for ALD.