Comparison of Medical Versus Surgical Unit Admissions for Acute Pancreatitis Patients
Document Type
Conference Proceeding
Publication Date
5-2024
Publication Title
Gastroenterology
Abstract
Introduction Acute Pancreatitis is an inflammatory disorder of the pancreas with a diverse etiology. It can be managed equally in medical and surgical units, but to our knowledge, few studies have evaluated the effect of admitting units on outcomes. It may be noted that the majority of these studies included only patients with gallstone pancreatitis. Our study aims to evaluate the trends in hospitalizations with acute pancreatitis of any etiology and differences in outcomes according to the unit of admission. Methods A multicentric retrospective review of hospitalized patients ≥18 years old at a major tertiary care health system in Michigan, USA from 2010-2019 was performed. Variables extracted included demographic details, admission/discharge dates, the first unit of admission from the emergency room, and biochemical parameters. Outcomes assessed were percentages of patients requiring intensive care unit (ICU) admission, length of stay, mortality, and 30- day readmission rate. Data were analyzed using Stata 14.1. Results A total of 11,019 patient hospitalizations (5350 [48.6%] female; mean age [±SD] was 55± [17.6] years) with acute pancreatitis were reviewed, out of which 8,712 were admitted to medical units and 2,044 to surgical units. Patients admitted to surgical units had a higher ICU admission rate (20.6% vs 4.8%, p< 0.001, table 1). Length of stay was shorter for patients admitted to medical units (4.1 vs 4.8 days, p< 0.0001), and the medical ICU (7 vs 9.1 days, p< 0.0001). Patients admitted under medical units had a lower mortality (1.3% vs 1.9%, p=0.025). There was no difference in 30-day readmission rates between medical and surgical units. Conclusion The length of stay and mortality is lower in patients with acute pancreatitis admitted under medical units compared to surgical, therefore showing effective management of pancreatitis in medical units. Differences in the severity of acute pancreatitis at admission, etiology, and the differences in clinical practice and patient volumes between the two units may have contributed to these differences. The management of acute pancreatitis remains a clinical challenge- both in terms of decisions regarding medical versus surgical management as well as appropriate patient placement in medical or surgical services. There is a need for well-designed studies to gather further evidence on differences in outcomes between units, considering baseline severity, etiology, and patient demographics. This will help guide the emergency physician in recommending admission to a medical or surgical unit for resource stewardship and better outcomes.
Volume
166
Issue
5 Suppl
First Page
S462
Recommended Citation
Singh A, Aggarwal N, Gill I, Neupane R, Goldman S, Schanz L, et al. [Bughrara M, Pandy S, Jamil LH, Aneese A]. Comparison of medical versus surgical unit admissions for acute pancreatitis patients. Gastroenterology. 2024 May;166(5 Suppl):S462. doi:10.1016/S0016-5085(24)01531-2
DOI
10.1016/S0016-5085(24)01531-2
Comments
DDW Digestive Disease Week, May 18-21, 2024, Washington, DC