Original articlePredictive factors for and incidence of hospital readmissions of patients with acute and chronic 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.
Section snippets
Methods
Patients that were admitted to hospital between 2006 and 2011 with the admission diagnosis of acute or chronic pancreatitis were screened regarding a later readmission with a pancreatitis-related diagnosis. Secondary data were obtained from the hospital information and reimbursement data system (HIS) of University Medicine Greifswald, a tertiary referral center with extensive experience in the care of patients with pancreatic diseases. Principal and secondary diagnoses as well as in-hospital
Results
Between 2006 and 2011 there were 774 hospitalizations at University Medicine Greifswald for acute or chronic pancreatitis as a main diagnosis and 606 hospitalizations remained after the application of exclusion criteria. Complete data from the HIS were available for 373 patients, mean age of the cohort was 55 years and the majority of patients were male (70.2%). The mean age at initial admission was 54.81 years (SD = 15.86). Further details on the patient cohort are given in Table 1. During the
Discussion
In this study we investigated parameters that predict hospital readmission of patients with either acute or chronic pancreatitis by bivariate and multivariate regression analysis. Out of 774 hospitalizations between 2006 and 2011 due to acute or chronic pancreatitis, complete data sets could be obtained for 606 cases (373 patients) from the hospital information and reimbursement data system (HIS). Prospective data from a questionnaire that was filled out by the patients at hospital admission
Specific authors contribution
TS, KK, SF and MML planning and conception of study. TS, KK:acquisition of data and statistical analysis. TS, AA and MML writing of manuscript. TS, AA, KK, PS, MML, JM, SF: revision and final approval of manuscript.
Acknowledgments
MML, PS, AA and JM were supported by grants from the Alfried-Krupp-von-Bohlen-und-Hahlbach-Foundation (Graduate Schools Tumour Biology and Free Radical Biology), the Deutsche Krebshilfe/Dr. Mildred-Scheel-Stiftung (109102), the Deutsche Forschungsgemeinschaft (DFG GRK840-E3/E4, MA 4115/1-2/3), the Federal Ministry of Education and Research (BMBF GANI-MED 03152061A and BMBF 0314107) and the European Union (EU-FP-7: EPC-TM and EU-FP7-REGPOT-2010-1) as well as unrestricted educational grants from
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