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.
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.
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).
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.
*Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
Departments of ‡Internal Medicine
§Gastroenterology, University of Minnesota Medical School, Minneapolis, MN
†Department of Hospital Medicine, Medicine Institute
¶Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH
∥Department of Public Health, University of Alabama, Birmingham, AL
S.K.G. and S.S. contributed equally.
S.K.G.: conceived the idea, designed study, conducted analysis, writing manuscript. S.S.: writing manuscript, critical appraisal of manuscript. J.P.C.: writing manuscript, critical appraisal of manuscript. I.O.: writing manuscript, critical appraisal of manuscript. F.B.: critical appraisal of manuscript. D.S.: writing manuscript, critical appraisal of manuscript. R.S.: writing manuscript, critical appraisal of manuscript. M.R.S.: critical appraisal of manuscript.
The authors declare that they have nothing to disclose.
Address correspondence to: Madhusudhan R. Sanaka, MD, FACG, FASGE, Department of Gastroenterology, Cleveland Clinic, Desk Q3, 9500 Euclid Ave., Cleveland, OH 44195 (e-mail: firstname.lastname@example.org).
Received November 18, 2017
Accepted February 20, 2018