Normalization of Serum Lipase Levels Versus Resolution of Abdominal Pain: A Comparison of Preoperative Management in Children With Biliary Pancreatitis

Factors Associated With Serial Lipase Measurement in Hospitalized Patients With Acute Pancreatitis

OBJECTIVES

To determine the factors associated with serial lipase measurement in patients with acute pancreatitis (AP).

METHODS

Patients admitted to Johns Hopkins Health System between September 2019 and August 2020 with lipase ≥3 times upper limit normal were prospectively identified. Acute pancreatitis was defined using revised Atlanta criteria. Serial lipase measurement was defined as >2 lipase measurements on consecutive days within 7 days of presentation.

RESULTS

There were 294 patients with AP with mean age 52.4 ± 16 years (SD), and 155 (52.7%) were male. A total of 227 (77.2%) were admitted to a medical service. There were 111 (37.7%) who underwent serial lipase measurements. There were 89 (30.8%), 36 (12.2%), 6 (1%), and 40 (13.6%) patients with systemic inflammatory response syndrome at time of initial lipase measurement, persistent organ failure, necrosis on admission, and intensive care unit admission. Serial lipase measurements were more likely to be obtained in patients admitted to surgical services (odds ratio, 4.3; 95% confidence interval, 1.4-13.2; P = 0.01) and nontertiary hospitals (odds ratio, 1.8; 95% confidence interval, 1.0-2.9; P = 0.04).

CONCLUSION

More than one-third of AP patients undergo serial lipase measurements. This practice is more likely to occur on surgical services and in nontertiary hospitals.

Weekend Admissions Associated with Increased Length of Stay for Children Undergoing Cholecystectomy

Background and Objectives:

Prior research shows an association between increased length of stay (LOS) and weekend surgical admissions, but none have looked at this relationship in children undergoing nonelective cholecystectomy for benign noncongenital biliary disease. We investigated whether weekend admissions lead to a longer LOS in this patient population.

Methods:

The Statewide Planning and Research Cooperative System database was queried for children ≤ 17 years undergoing cholecystectomy in New York State between January 1, 2009 and December 31, 2012. Parametric and nonparametric statistical testing was used for univariate analysis; multivariable binary logistic regression and linear regression models were used for multivariable analysis. Statistical significance was < 0.05.

Results:

A total of 1066 pediatric patients underwent nonelective cholecystectomy for gallstone pancreatitis (9.7%) and other benign biliary noncongenital diseases (90.3%), of which 22.1% of all patients were admitted over the weekend. Most cases (97.2%) were treated laparoscopically with an overall 3-day median LOS. Weekend admission was associated with an increased LOS of 4 days as opposed to 3 days during the weekday (p < 0.001). On a multivariable binary logistic regression model controlling for hospital factors, indication for surgery, and comorbidities, weekend admission was associated with 1.92 odds of increased length of stay (adjusted odds ratio of 1.924, 95% confidence interval: 1.386–2.673).

Conclusion:

Weekend admissions were associated with increased LOS and charges for children requiring nonelective cholecystectomy, despite the wide use of laparoscopic surgery.