Skip to main content

Advertisement

Log in

Characteristics of 30-Day All-Cause Hospital Readmissions Among Patients with Acute Pancreatitis and Substance Use

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

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.

Methods

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.

Results

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.

Conclusion

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Kripalani S, Theobald CN, Anctil B, Vasilevskis EE. Reducing hospital readmission rates: current strategies and future directions. Ann Rev Med. 2014;65:471–485.

    Article  CAS  PubMed  Google Scholar 

  2. Tenner S, Baillie J, DeWitt J, Vege SS. American College of Gastroenterology guideline: management of acute pancreatitis. Off J Am College Gastroenterol ACG. 2013;108:1400–1415.

    Article  CAS  Google Scholar 

  3. Dong E, Chang JI, Verma D, Butler RK, Villarin CK, Kwok KK et al. Enhanced recovery in mild acute pancreatitis: a randomized controlled trial. Pancreas. 2019;48:176–181.

    Article  CAS  PubMed  Google Scholar 

  4. Yang AL, Jin DX, Srivoleti P, Banks PA, McNabb-Baltar J. Are opioid-naive patients with acute pancreatitis given opioid prescriptions at discharge? Pancreas. 2019;48:1397–1399.

    Article  PubMed  Google Scholar 

  5. Hudgins JD, Porter JJ, Monuteaux MC, Bourgeois FT. Prescription opioid use and misuse among adolescents and young adults in the United States: a national survey study. PLoS Med. 2019;16:e1002922.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Zilio MB, Eyff TF, Azeredo-Da-Silva AL, Bersch VP, Osvaldt AB. A systematic review and meta-analysis of the aetiology of acute pancreatitis. HPB. 2019;21:259–267.

    Article  PubMed  Google Scholar 

  7. Samokhvalov AV, Rehm J, Roerecke M. Alcohol consumption as a risk factor for acute and chronic pancreatitis: a systematic review and a series of meta-analyses. EBioMedicine. 2015;2:1996–2002.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Magnusdottir BA, Baldursdottir MB, Kalaitzakis E, Björnsson ES. Risk factors for chronic and recurrent pancreatitis after first attack of acute pancreatitis. Scand J Gastroenterol. 2019;54:87–94.

    Article  PubMed  Google Scholar 

  9. Aune D, Mahamat-Saleh Y, Norat T, Riboli E. Tobacco smoking and the risk of pancreatitis: a systematic review and meta-analysis of prospective studies. Pancreatology. 2019;19:1009–1022.

    Article  PubMed  Google Scholar 

  10. Charilaou P, Mohapatra S, Joshi T, Devani K, Gadiparthi C, Pitchumoni CS et al. Opioid use disorder in admissions for acute exacerbations of chronic pancreatitis and 30-day readmission risk: a nationwide matched analysis. Pancreatology. 2020;20:35–43.

    Article  CAS  PubMed  Google Scholar 

  11. Barkin JA, Nemeth Z, Saluja AK, Barkin JS. Cannabis-induced acute pancreatitis: a systematic review. Pancreas. 2017;46:1035–1038.

    Article  PubMed  Google Scholar 

  12. 2017 Introduction to the NRD. Healthcare Cost and Utilization Project (HCUP). March 2020. Agency for Healthcare Research and Quality, MD. 2020 [Available from: www.hcup-us.ahrq.gov/db/nation/nrd/Introduction_NRD_2010-2017.jsp.

  13. Free 2019 ICD-10-CM Codes - ICD-10 Data https://www.icd10data.com/ICD10CM/Codes - Google Search2019. Available from: https://www.google.com/search?q=Free+2019+ICD-10-CM+Codes+-+ICD-10+Data+https%3A%2F%2Fwww.icd10data.com%2FICD10CM%2FCodes&oq=Free+2019+ICD-10-CM+Codes+-+ICD-10+Data+https%3A%2F%2Fwww.icd10data.com%2FICD10CM%2FCodes&aqs=chrome..69i57.2647j0j4&sourceid=chrome&ie=UTF-8.

  14. Argueta PP, Salazar M, Vohra I, Corral JE, Lukens FJ, Vargo JJ et al. Thirty-day readmission among patients with alcoholic acute pancreatitis. Dig Dis Sci. 2021;66:4227–4236. https://doi.org/10.1007/s10620-020-06765-7.

    Article  PubMed  Google Scholar 

  15. Yegneswaran B, Kostis JB, Pitchumoni C. Cardiovascular manifestations of acute pancreatitis. J Crit Care. 2011;26:225-e11–e18.

    Article  Google Scholar 

  16. Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45:613–619.

    Article  CAS  PubMed  Google Scholar 

  17. Group USC. REGRESSION WITH STATA CHAPTER 2 – REGRESSION DIAGNOSTICS. Available from: https://stats.idre.ucla.edu/stata/webbooks/reg/chapter2/stata-webbooksregressionwith-statachapter-2-regression-diagnostics/.

  18. Abuse NIoD. Costs of Substance Abuse. 2020.

  19. Key Substance Use and Mental Health Indicators in the United States: results from the 2017 National Survey on Drug Use and Health. 2017.

  20. Peery AF, Crockett SD, Barritt AS, Dellon ES, Eluri S, Gangarosa LM et al. Burden of gastrointestinal, liver, and pancreatic diseases in the United States. Gastroenterology. 2015;149:1731–41.

    Article  PubMed  Google Scholar 

  21. Clark RE, Samnaliev M, McGovern MP. Impact of substance disorders on medical expenditures for Medicaid beneficiaries with behavioral health disorders. Psychiatr Serv. 2009;60:35–42.

    Article  PubMed  Google Scholar 

  22. Reif S, Acevedo A, Garnick DW, Fullerton CA. Reducing behavioral health inpatient readmissions for people with substance use disorders: Do follow-up services matter? Psychiatr Serv. 2017;68:810–818.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Becker MA, Boaz TL, Andel R, Hafner S. Risk of early rehospitalization for non-behavioral health conditions among adult Medicaid beneficiaries with severe mental illness or substance use disorders. J Behav Health Serv Res. 2017;44:113–121.

    Article  PubMed  Google Scholar 

  24. Statistical Brief #249. Healthcare Cost and Utilization Project (HCUP). March 2019. Agency for Healthcare Research and Quality, Rockville, MD [Available from: www.hcup-us.ahrq.gov/reports/statbriefs/sb249-Mental-Substance-Use-Disorder-Hospital-Stays-2016.jsp.

  25. Lipari RN, Van Horn SL. Trends in substance use disorders among adults aged 18 or older. 2017.

  26. Whitlock TL, Repas K, Tignor A, Conwell D, Singh V, Banks PA et al. Early readmission in acute pancreatitis: incidence and risk factors. Am J Gastroenterol. 2010;105:2492–2497.

    Article  PubMed  Google Scholar 

  27. CMS.gov. Hospital Readmissions Reduction Program (HRRP) [Available from: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/HRRP/Hospital-Readmission-Reduction-Program.

  28. Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009;360:1418–1428.

    Article  CAS  PubMed  Google Scholar 

  29. Shah R, Haydek C, Mulki R, Qayed E. Incidence and predictors of 30-day readmissions in patients hospitalized with chronic pancreatitis: a nationwide analysis. Pancreatology. 2018;18:386–393.

    Article  PubMed  Google Scholar 

  30. Fisher AV, Sutton JM, Wilson GC, Hanseman DJ, Abbott DE, Smith MT et al. High readmission rates after surgery for chronic pancreatitis. Surgery. 2014;156:787–794.

    Article  PubMed  Google Scholar 

  31. Choi M, Kim H, Qian H, Palepu A. Readmission rates of patients discharged against medical advice: a matched cohort study. PLoS ONE. 2011;6:e24459.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Southern WN, Nahvi S, Arnsten JH. Increased risk of mortality and readmission among patients discharged against medical advice. Am J Med. 2012;125:594–602.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Ti L, Ti L. Leaving the hospital against medical advice among people who use illicit drugs: a systematic review. Am J Public Health. 2015;105:e53–e59.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Simon R, Snow R, Wakeman S. Understanding why patients with substance use disorders leave the hospital against medical advice: a qualitative study. Subst Abuse. 2020;41:519–525.

    Article  Google Scholar 

  35. Overview of Disease Severity Measures. Healthcare Cost and Utilization Project (HCUP). March 2006. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/db/nation/nis/severity_overview.jsp.

  36. Kwok CS, Martinez SC, Pancholy S, Ahmed W, Al-Shaibi K, Potts J et al. Effect of comorbidity on unplanned readmissions after percutaneous coronary intervention (from the nationwide readmission database). Sci Rep. 2018;8:11156.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Horwitz LI, Lin Z, Herrin J, Bernheim S, Drye EE, Krumholz HM et al. Association of hospital volume with readmission rates: a retrospective cross-sectional study. BMJ. 2015;350:h447.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Joynt KE, Orav EJ, Jha AK. The association between hospital volume and processes, outcomes, and costs of care for congestive heart failure. Ann Intern Med. 2011;154:94–102.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Horwitz LI, Lin Z, Herrin J, Bernheim S, Drye EE, Krumholz HM, et al. Association of hospital volume with readmission rates: a retrospective cross-sectional study. BMJ. 2015;350.

  40. Abougergi MS, Peluso H, Saltzman JR. Thirty-day readmission among patients with non-variceal upper gastrointestinal hemorrhage and effects on outcomes. Gastroenterology. 2018;155:38–46.

    Article  PubMed  Google Scholar 

  41. Klabunde CN, Warren JL, Legler JM. Assessing comorbidity using claims data: an overview. Med Care. 2002:IV26–IV35.

  42. Bowman SE. Why ICD-10 is worth the trouble. J AHIMA. 2008;79:24–29.

    PubMed  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Julia McNabb-Baltar.

Ethics declarations

Conflict of interest

VK, RDD, ALY, DXJ, PAB have no conflict of interest to declare. JMB: Consultant for Nestle Health.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (XLSX 14 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kumar, V., Dolan, R.D., Yang, A.L. et al. Characteristics of 30-Day All-Cause Hospital Readmissions Among Patients with Acute Pancreatitis and Substance Use. Dig Dis Sci 67, 5500–5510 (2022). https://doi.org/10.1007/s10620-022-07463-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-022-07463-2

Keywords

Navigation