Department of General Internal Medicine, Brigham and Women's Hospital Harvard Medical School, Boston, MA, USA.
Division of Gastroenterology, Hepatology, and Endoscopy, Center for Pancreatic Disease, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
Dig Dis Sci. 2022 Dec;67(12):5500-5510. doi: 10.1007/s10620-022-07463-2. Epub 2022 Mar 29.
BACKGROUND/OBJECTIVES: Previous studies on healthcare resource utilization and 30-day readmission risks among patients with acute pancreatitis (AP) have focused upon opioid and alcohol use. The data on other substance types are lacking. In this study we aim to estimate the 30-day readmission rates, predictors of readmission, impact of readmission on patient outcomes and resulting economic burden among patients with AP and substance use in the USA.
This was a retrospective cohort study, based upon data from 2017 National Readmission Database of adult patients with AP and substance use (alcohol in combination, opioid, cannabis, cocaine, sedatives, other stimulants, other hallucinogens, other psychoactive, inhalant and miscellaneous). We estimated the 30-day readmission rates and predictors of 30-day readmission.
Among 25,795 eligible patients, most were male, belonged to the lower income quartile, resided in the urban facility and had a Charlson comorbidity score of 0 or 1. The use of a combination of substances was the most common in 17,265 (66.9%) patients followed by only opioids in 4691 (18.2%) patients and only marijuana in 3839 (14.9%) patients. A total of 14.6% patients were readmitted within 30 days after discharge for non-elective causes with the highest risk of readmission within the 1st week after discharge with 5.2% readmissions. Among top ten causes of readmission, most of the principal diagnosis were related to AP in 53.1%. Compared to index admission, readmitted patients had significantly higher rates of acute cardiac failure, shock, and higher in-hospital mortality rate. Overall, readmission attributed to an additional 17,801 days of hospitalization resulting in a total of $150 million in hospitalization charges and $36 million in hospitalization costs in 2017. On multivariate analysis, chronic pancreatitis, self-discharge against medical advice, treatment at the highest volume centers, higher Charlson comorbidity index, increasing length of stay and severe disease were associated with higher odds of readmission while female gender and private insurance were associated with lower odds.
Readmission was associated with higher morbidity and in-hospital mortality among patients with AP and substance use and resulted in a significant monetary burden on the US healthcare system. Several factors identified in this study may be useful for categorizing patients at higher risk of readmission warranting special attention during discharge planning.
背景/目的：之前关于急性胰腺炎（AP）患者医疗资源利用和 30 天再入院风险的研究主要集中在阿片类药物和酒精使用上。关于其他物质类型的数据则有所欠缺。本研究旨在估计美国 AP 合并物质使用患者的 30 天再入院率、再入院预测因素、再入院对患者结局的影响以及由此产生的经济负担。
这是一项基于 2017 年国家再入院数据库中成年 AP 合并物质使用（酒精联合使用、阿片类药物、大麻、可卡因、镇静剂、其他兴奋剂、其他致幻剂、其他精神活性物质、吸入剂和其他杂项）患者的回顾性队列研究，我们估计了 30 天再入院率和 30 天再入院预测因素。
在 25795 名合格患者中，大多数为男性，收入处于较低四分位，居住在城市医疗机构，Charlson 合并症评分为 0 或 1。17265 名（66.9%）患者最常使用多种物质联合，4691 名（18.2%）患者仅使用阿片类药物，3839 名（14.9%）患者仅使用大麻。共有 14.6%的患者因非择期原因在出院后 30 天内再次入院，出院后第 1 周的再入院风险最高，有 5.2%的患者再入院。在再入院的十大主要原因中，大多数主要诊断与 AP 有关，占 53.1%。与首次入院相比，再入院患者急性心功能衰竭、休克发生率更高，院内死亡率更高。总体而言，再入院导致额外 17801 天的住院治疗，导致 2017 年住院费用增加 1.5 亿美元，住院费用增加 3600 万美元。多变量分析显示，慢性胰腺炎、自行出院、在最高容量中心治疗、Charlson 合并症指数较高、住院时间延长和疾病严重程度与再入院风险增加相关，而女性和私人保险与再入院风险降低相关。
AP 合并物质使用患者再入院与更高的发病率和院内死亡率相关，并给美国医疗保健系统带来了巨大的经济负担。本研究确定的几个因素可能有助于对再入院风险较高的患者进行分类，这在出院计划期间需要特别关注。
