Predictive factors for and incidence of hospital readmissions of patients with acute and chronic pancreatitis

Abstract

Background/objective

Acute and chronic pancreatitis are common gastroenterological disorders that have a fairly unpredictable long-term course often associated with unplanned hospital readmissions. Little is known about the factors that increase or decrease the risk for a hospital readmission. The aim of this study was to identify positive and negative predictive factors for hospital readmissions of patients with acute and chronic pancreatitis after in-hospital treatment.

Methods

In a retrospective analysis data from the hospital information and reimbursement data system (HIS) were evaluated for 606 hospital stays for either acute or chronic pancreatitis between 2006 and 2011. Additional clinical data were obtained from a questionnaire covering quality of life and socio-economic status. A total of 973 patient variables were assessed by bivariate and multivariate analysis.

Results

Between 2006 and 2011, 373 patients were admitted for acute or chronic pancreatitis; 107 patients of them were readmitted and 266 had only one hospitalization. Predictors for readmission were concomitant liver disease, presence of a pseudocyst or a suspected tumor of the pancreas as well as alcohol, tobacco or substance abuse or coexisting mental disorders. Patients who had undergone a CT-scan were more susceptible to readmission. Lower readmissions rates were found in patients with diabetes mellitus or gallstone disease as co-morbidity.

Conclusion

While factors like age and severity of the initial disease cannot be influenced to reduce the readmission rate for pancreatitis, variables like alcohol, tobacco and drug abuse can be addressed in outpatient programs to reduce disease recurrence and readmission rates for pancreatitis.

Introduction

A readmission is defined as a re-hospitalization of a patient due to the same principal diagnosis as for the first hospital stay within a defined period of time. This can be an indicator of either premature discharge [1], poor quality of hospital services [2], [3], [4], insufficient ambulatory care [5] or a disease with a high probability of recurrence [6]. According to the German hospital financing system (G-DRG) a readmission within 30 days will usually mean that the first admission and the readmission are bundled and thus reimbursed as one rebate case. This usually leads to insufficient coverage of the objective cost incurred by the hospital and causes a financial deficit. There are therefore economic reasons in addition to medical ones for investigating the risk factors for hospital readmissions and especially early readmissions.

In 2005, the average Medicare payment per potentially preventable readmission was $ 7200 in the United States. At the same time, 13.3% of early (i.e. within the first 30 days after initial stay) readmissions are thought to be avoidable. Thus, preventable early readmissions could generate annual savings of about 12 billion Dollars [3]. Gastrointestinal diseases are a major cause of readmission [7] and among them [6] acute and chronic pancreatitis are disproportionately represented [8]. Acute pancreatitis (AP) has an incidence of 10-79/100,000 and the incidence of chronic pancreatitis (CP) is around 23/100,000 [9], [10], [11]. There seems to be a broad consensus that the incidence and number of hospital admissions due to acute or chronic pancreatitis is increasing [12], [13], [14]. 19% of patients with AP suffer from recurrence of the disease and therefore undergo early readmission within the first 30 days after the initial discharge, i.e. the risk of early readmission of patients with AP is particularly high [15]. Therefore pancreatic disorders, in particular acute and chronic pancreatitis are excellent examples for the high medical and economic relevance of an analysis of readmissions. Assessment of the risk and predictive factors for readmissions could make an important contribution to improvements in quality of care and lead to cost containment [15]. However, our knowledge of these risk factors is rather limited. Whitlock et al., 2010 [15] analyzed patients with AP regarding re-hospitalizations within the first 30 days. They found that alcohol consumption, which was also the etiologic factor of the disease, persistence of symptoms and non-restored oral food intake at discharge, were risk factors for early readmission. For disease recurrence the severity of the initial episode was also identified as a risk factor [6]. Furthermore, delayed cholecystectomy was found to be a risk factor for a readmission in gallstone induced AP [16], [17], [18], [19]. So far no in-detail analysis of predisposing factors for readmission of patients with pancreatitis-related diseases covering an extended period of time after the initial hospital treatment has been performed that included concomitant disorders as well as medical diagnostic and therapeutic procedures. This prompted us to conduct such an analysis in a tertiary referral center.