Reducing Hospitalization in Mild Acute Pancreatitis: Results of Long-term Follow-up.

Journal Article (Journal Article)

GOALS AND BACKGROUND: Acute pancreatitis (AP) is a common emergency department (ED) diagnosis, amounting to enormous costs. Our previous pilot study demonstrated the feasibility of reducing hospitalization using an ED-based observation pathway. In this follow-up study, we hypothesize that the pathway is durable in clinical practice, outside of research supervision, and patients can safely be managed without hospitalization. STUDY: We reviewed patients prospectively enrolled in the observation pathway after the end of the pilot study. We compared outcomes to patients enrolled in our pilot study and with a historic cohort of patients admitted with mild AP. Our primary outcome was hospitalization rate during the enrollment period and secondary outcomes included length of stay, 30-day readmissions, mortality, and health care utilization. RESULTS: Over a 2-year period 165 patients met criteria for AP with 118 (71.5%) having mild AP. Fifty-four of 118 patients (45.8%) were enrolled in the observation pathway and of these, 45 patients were discharged from the ED, reducing hospitalization by 31.2%, compared with pilot study (22.2%) and historic cohort (0%) (P<0.05). Median length of stay was shorter [19.9 (observation) vs. 72.0 h (historic cohort), P<0.01]. There were fewer radiographic examinations in the observation cohorts (pilot and current study) than in the historic cohort (P<0.05), with similar 30-day readmissions, and no reported deaths. CONCLUSIONS: This follow-up study demonstrates the durability of an observation-based pathway to manage mild AP outside of a research protocol and maintain its ability to reduce hospitalizations without affecting readmission rates or mortality.

Full Text

Duke Authors

Cited Authors

  • Ahmed, A; Kothari, DJ; Wardlaw, S; Freedman, SD; Sheth, SG

Published Date

  • February 1, 2021

Published In

Volume / Issue

  • 55 / 2

Start / End Page

  • 180 - 186

PubMed ID

  • 32301837

Pubmed Central ID

  • 32301837

Electronic International Standard Serial Number (EISSN)

  • 1539-2031

Digital Object Identifier (DOI)

  • 10.1097/MCG.0000000000001354

Language

  • eng

Conference Location

  • United States