Acute biliary pancreatitis has better outcomes but increased resource utilization compared to acute alcohol-induced pancreatitis: insights from a nationwide study

Sachit Sharma; Christian Nehme; Muhammad Aziz; Simcha Weissman; Ahmad Khan; Ashu Acharya; Ishaan Vohra; Sami Ghazaleh; Ali Nawras; Douglas G Adler

doi:10.20524/aog.2020.0559

Acute biliary pancreatitis has better outcomes but increased resource utilization compared to acute alcohol-induced pancreatitis: insights from a nationwide study

Ann Gastroenterol. 2021;34(2):253-261. doi: 10.20524/aog.2020.0559. Epub 2020 Dec 7.

Authors

Affiliations

¹ Department of Medicine, University of Toledo Medical Center, Toledo, OH (Sachit Sharma, Christian Nehme, Muhammad Aziz, Ashu Acharya, Sami Ghazaleh).
² Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ (Simcha Weissman).
³ Department of Medicine, West Virginia University Health Sciences Center Charleston Division, Charleston, WV (Ahmad Khan).
⁴ Department of Medicine, John H. Stroger Jr, Hospital of Cook County, Chicago, IL (Ishaan Vohra).
⁵ Department of Gastroenterology, The University of Toledo Medical Center, Toledo, OH (Ali Nawras).
⁶ Department of Gastroenterology, University of Utah, Salt Lake City, UT (Douglas G. Adler), USA.

Abstract

Background: The differences in outcomes between acute biliary pancreatitis (ABP) and acute alcohol-induced pancreatitis (AAP) have not been well studied. We sought to examine the differences between ABP and AAP as regards to in-hospital outcomes and resource utilization, using a large nationwide database.

Methods: We queried the National Inpatient Sample databases 2016 and 2017 using the International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) coding system to identify the patients with a primary diagnosis of AAP and ABP. The primary outcome was all-cause in-hospital mortality. Secondary outcomes were hospital length of stay (LOS), hospitalization charge/cost, shock, acute kidney injury (AKI), intensive care unit (ICU) admission, and home discharge. Analysis was performed with STATA software.

Results: There was no significant difference in mortality between patients with AAP and ABP (0.42% vs. 0.82%, adjusted odds ratio [aOR] 0.95, 95% confidence interval [CI] 0.69-1.31; P=0.79). Patients with ABP had a significantly longer LOS (+0.48 days, P<0.001). Patients with ABP had significantly higher adjusted mean hospitalization charges ($+19,958, P<0.001) and costs ($+4,848, P<0.001). Patients with ABP had a significantly lower likelihood of shock (aOR 0.75, 95%CI 0.59-0.95; P=0.02), AKI (aOR 0.76, 95%CI 0.71-0.82; P<0.001) or ICU admission (aOR 0.74, 95%CI 0.62-0.88; P=0.001). They were more likely to be discharged home (aOR 1.26, 95%CI 1.18-1.34; P<0.001).

Conclusion: Although there was no difference in all-cause mortality, patients with ABP had better hospitalization outcomes but greater resource utilization.

Keywords: Acute biliary pancreatitis; acute alcohol-induced pancreatitis; mortality; outcomes; resource utilization.