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Ali H, Inayat F, Rasheed W, Afzal A, Chaudhry A, Patel P, Rehman AU, Anwar MS, Nawaz G, Afzal MS, Sohail AH, Subramanium S, Dahiya DS, Budh D, Mohan BP, Adler DG. Association between acute peripancreatic fluid collections and early readmission in acute pancreatitis: A propensity-matched analysis. World J Exp Med 2024; 14:92052. [PMID: 38948418 PMCID: PMC11212740 DOI: 10.5493/wjem.v14.i2.92052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/15/2024] [Accepted: 04/09/2024] [Indexed: 06/19/2024] Open
Abstract
BACKGROUND Patients with acute pancreatitis (AP) frequently experience hospital readmissions, posing a significant burden to healthcare systems. Acute peripancreatic fluid collection (APFC) may negatively impact the clinical course of AP. It could worsen symptoms and potentially lead to additional complications. However, clinical evidence regarding the specific association between APFC and early readmission in AP remains scarce. Understanding the link between APFC and readmission may help improve clinical care for AP patients and reduce healthcare costs. AIM To evaluate the association between APFC and 30-day readmission in patients with AP. METHODS This retrospective cohort study is based on the Nationwide Readmission Database for 2016-2019. Patients with a primary diagnosis of AP were identified. Participants were categorized into those with and without APFC. A 1:1 propensity score matching for age, gender, and Elixhauser comorbidities was performed. The primary outcome was early readmission rates. Secondary outcomes included the incidence of inpatient complications and healthcare utilization. Unadjusted analyses used Mann-Whitney U and χ 2 tests, while Cox regression models assessed 30-day readmission risks and reported them as adjusted hazard ratios (aHR). Kaplan-Meier curves and log-rank tests verified readmission risks. RESULTS A total of 673059 patients with the principal diagnosis of AP were included. Of these, 5.1% had APFC on initial admission. After propensity score matching, each cohort consisted of 33914 patients. Those with APFC showed a higher incidence of inpatient complications, including septic shock (3.1% vs 1.3%, P < 0.001), portal venous thrombosis (4.4% vs 0.8%, P < 0.001), and mechanical ventilation (1.8% vs 0.9%, P < 0.001). The length of stay (LOS) was longer for APFC patients [4 (3-7) vs 3 (2-5) days, P < 0.001], as were hospital charges ($29451 vs $24418, P < 0.001). For 30-day readmissions, APFC patients had a higher rate (15.7% vs 6.5%, P < 0.001) and a longer median readmission LOS (4 vs 3 days, P < 0.001). The APFC group also had higher readmission charges ($28282 vs $22865, P < 0.001). The presence of APFC increased the risk of readmission twofold (aHR 2.52, 95% confidence interval: 2.40-2.65, P < 0.001). The independent risk factors for 30-day readmission included female gender, Elixhauser Comorbidity Index ≥ 3, chronic pulmonary diseases, chronic renal disease, protein-calorie malnutrition, substance use disorder, depression, portal and splenic venous thrombosis, and certain endoscopic procedures. CONCLUSION Developing APFC during index hospitalization for AP is linked to higher readmission rates, more inpatient complications, longer LOS, and increased healthcare costs. Knowing predictors of readmission can help target high-risk patients, reducing healthcare burdens.
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Affiliation(s)
- Hassam Ali
- Department of Gastroenterology and Hepatology, East Carolina University Brody School of Medicine, Greenville, NC 27834, United States
| | - Faisal Inayat
- Department of Internal Medicine, Allama Iqbal Medical College, Lahore, Punjab 54550, Pakistan
| | - Waqas Rasheed
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, United States
| | - Arslan Afzal
- Department of Gastroenterology and Hepatology, East Carolina University Brody School of Medicine, Greenville, NC 27834, United States
| | - Ahtshamullah Chaudhry
- Department of Internal Medicine, St. Dominic’s Hospital, Jackson, MS 39216, United States
| | - Pratik Patel
- Department of Gastroenterology, Mather Hospital and Hofstra University Zucker School of Medicine, Port Jefferson, NY 11777, United States
| | - Attiq Ur Rehman
- Department of Hepatology, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA 18711, United States
| | - Muhammad Sajeel Anwar
- Department of Internal Medicine, UHS Wilson Medical Center, Johnson City, NY 13790, United States
| | - Gul Nawaz
- Department of Internal Medicine, Allama Iqbal Medical College, Lahore, Punjab 54550, Pakistan
| | - Muhammad Sohaib Afzal
- Department of Internal Medicine, Louisiana State University Health, Shreveport, LA 71103, United States
| | - Amir H Sohail
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM 87106, United States
| | - Subanandhini Subramanium
- Department of Gastroenterology and Hepatology, East Carolina University Brody School of Medicine, Greenville, NC 27834, United States
| | - Dushyant Singh Dahiya
- Division of Gastroenterology, Hepatology, and Motility, The University of Kansas School of Medicine, Kansas City, KS 64108, United States
| | - Deepa Budh
- Department of Internal Medicine, St. Barnabas Hospital and Albert Einstein College of Medicine, Bronx, NY 10457, United States
| | - Babu P Mohan
- Department of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, UT 84132, United States
| | - Douglas G Adler
- Center for Advanced Therapeutic Endoscopy, Porter Adventist Hospital, Centura Health, Denver, CO 80210, United States
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Pasqualetto AF, Boroni G, Moneghini D, Parolini F, Orizio P, Bulotta AL, Missale G, Alberti D. Single Center Experience of Eus-Guided Cystogastrostomy and Lumen-Apposing Metal Stent (LAMS) Positioning in Children with Pancreatic Fluid Collections: A Case Series. CHILDREN (BASEL, SWITZERLAND) 2024; 11:643. [PMID: 38929223 PMCID: PMC11202220 DOI: 10.3390/children11060643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/04/2024] [Accepted: 05/24/2024] [Indexed: 06/28/2024]
Abstract
Pancreatic fluid collections (PFCs) are a well-known complication of pancreatitis. PFCs operative management includes percutaneous, endoscopic or surgical drainage. Even if in adult patients, endoscopic drainage is a well-established treatment, few data are available in pediatric setting. We report our single-center experience of EUS-guided cystogastrostomy and lumen-apposing metal stent (LAMS) positioning in children with PFCs; this, at the best of our knowledge, has never been reported before. All consecutive children with PFCs between April 2020 and November 2022 were enrolled in this retrospective study. PFCs were preoperatively evaluated with MRI or CT scan. All the procedures were performed under general anesthesia. A LAMS Hot-AxiosTM 10 × 15 mm was placed in all patients. We evaluated technical feasibility and clinical outcomes, including complications and recurrence rates. Follow-up included clinical observation, blood tests and US. EUS-guided cystogastrostomy was performed in 3 children (2 males; median age 13.2 years). Median maximum cyst diameter was 14.7 cm (range 10-22 cm). Technical and clinical success rates were 100%. No intra or post-operative complications occurred. Our experience suggests that this can be considered a safe and feasible treatment of PCFs even in the pediatric population, as long as the procedure is performed by an expert Endoscopist in a pediatric tertiary-level Center.
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Affiliation(s)
- Annalisa Fiammetta Pasqualetto
- Department of Pediatric Surgery, ASST Spedali Civili Children’s Hospital, 25123 Brescia, Italy; (A.F.P.); (G.B.); (F.P.); (P.O.); (A.L.B.)
| | - Giovanni Boroni
- Department of Pediatric Surgery, ASST Spedali Civili Children’s Hospital, 25123 Brescia, Italy; (A.F.P.); (G.B.); (F.P.); (P.O.); (A.L.B.)
- European Reference Network for Hepatological Diseases (ERN RARE-LIVER)
| | - Dario Moneghini
- Department of Digestive and Interventional Endoscopy, ASST Spedali Civili, 25123 Brescia, Italy; (D.M.); (G.M.)
| | - Filippo Parolini
- Department of Pediatric Surgery, ASST Spedali Civili Children’s Hospital, 25123 Brescia, Italy; (A.F.P.); (G.B.); (F.P.); (P.O.); (A.L.B.)
- European Reference Network for Hepatological Diseases (ERN RARE-LIVER)
| | - Paolo Orizio
- Department of Pediatric Surgery, ASST Spedali Civili Children’s Hospital, 25123 Brescia, Italy; (A.F.P.); (G.B.); (F.P.); (P.O.); (A.L.B.)
| | - Anna Lavinia Bulotta
- Department of Pediatric Surgery, ASST Spedali Civili Children’s Hospital, 25123 Brescia, Italy; (A.F.P.); (G.B.); (F.P.); (P.O.); (A.L.B.)
| | - Guido Missale
- Department of Digestive and Interventional Endoscopy, ASST Spedali Civili, 25123 Brescia, Italy; (D.M.); (G.M.)
| | - Daniele Alberti
- Department of Pediatric Surgery, ASST Spedali Civili Children’s Hospital, 25123 Brescia, Italy; (A.F.P.); (G.B.); (F.P.); (P.O.); (A.L.B.)
- European Reference Network for Hepatological Diseases (ERN RARE-LIVER)
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy
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Tian Y, Yin C, Ma Y, Fu G, Liu R, Ran H, Pan T, Xiao Y, Wen X. Lumen-apposing metal stents versus traditional self-expanding metal stents for endoscopic ultrasound-guided drainage of pancreatic fluid collections: a systematic review and meta-analysis. Surg Endosc 2024; 38:586-596. [PMID: 38151677 DOI: 10.1007/s00464-023-10636-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 11/29/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Endoscopic drainage has become the preferred treatment for pancreatic fluid collections (PFCs). There is still a lack of reliable evidence to prove which metal stent is the best choice for endoscopic ultrasound (EUS)-guided drainage of PFCs. In this study, we aimed to evaluate the efficacy and safety of lumen-apposing metal stents (LAMS) compared to traditional self-expanding metal stents (SEMS) in meta-analysis. METHODS We systematically searched PubMed, Embase, Web of Science, and Cochrane Library up to July 15, 2023. Relevant publications that compared LAMS with traditional SEMS for drainage of patients' PFCs under EUS-guidance were included. This meta-analysis assessed endpoints using Review Manager 5.3 and Stata 14.0 statistical software. RESULT Nine citations comprising 707 patients with PFCs were included. The clinical success rate of LAMS tended to be higher than that of SEMS (RR = 1.07, 95%CI [1.00, 1.15], P = 0.05). LAMS had a lower technical success rate (RR = 0.97, 95%CI [0.94, 0.99], P = 0.02) and faster procedure time (minutes) (MD = - 24.29, 95%CI [- 25.59, - 22.99], P < 0.00001) compared to SEMS. In addition, LAMS had fewer overall adverse events (RR = 0.64, 95%CI [0.48, 0.87], P = 0.004). For specific adverse events, LAMS had fewer migration (RR = 0.37, 95%CI [0.19, 0.72], P = 0.003), occlusion (RR = 0.43, 95%CI [0.22, 0.82], P = 0.01) and infection (RR = 0.38, 95%CI [0.20, 0.70], P = 0.002). There was no significant difference in bleeding and perforation between the two stents. For hospital stay (days), LAMS group was similar to SEMS group (MD = - 3.34, 95%CI [- 7.71, - 1.03], P = 0.13). Regarding recurrence, LAMS group was fewer than SEMS group (RR = 0.41, 95%CI [0.21, 0.78], P = 0.007). CONCLUSION Compared to traditional SEMS, LAMS has a higher clinical success rate, faster procedure time, fewer adverse events, similar hospital stay and lower recurrence rate in EUS-guided drainage of PFCs. LAMS is a good choice with a high technical success rate over 95%, and using a shorter length or "one-step" operation can further improve it. Richer placement experience is required for LAMS placement under EUS-guidance.
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Affiliation(s)
- Yong Tian
- Department of Gastroenterology, Chengdu First People's Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- Clinical Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Changjie Yin
- People's Liberation Army, The General Hospital of Western Theater Command, Chengdu, Sichuan, China
| | - Yihan Ma
- Department of Gastroenterology, Chengdu First People's Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Guochuan Fu
- Department of Gastroenterology, Chengdu First People's Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Rui Liu
- Clinical Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Hongmei Ran
- Department of Gastroenterology, Chengdu First People's Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Tao Pan
- Department of Gastroenterology, Chengdu First People's Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yang Xiao
- Clinical Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Xudong Wen
- Department of Gastroenterology, Chengdu First People's Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China.
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Almohammadi AA, Aljafri OH, Esawi HH, Alzhrani AA, Alharbi MS. The Etiology and Epidemiological Features of Acute Pancreatitis in Saudi Arabia: A Systematic Review. Cureus 2023; 15:e46511. [PMID: 37927657 PMCID: PMC10625166 DOI: 10.7759/cureus.46511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 11/07/2023] Open
Abstract
We aimed to identify the etiology of acute pancreatitis (AP) and its most common causes with its epidemiological features among the Saudi population in 2023 in different regions. In this systematic review, we assessed the etiology and epidemiological features of acute pancreatitis in Saudi Arabia following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 guidelines. Inclusion criteria were studies conducted in Saudi Arabia, published in English, and involving participants aged 18 years or older. PubMed and Google Scholar were searched in March 2023 for English articles published between 1985 and 2023 using specific keywords. Two reviewers screened titles, abstracts, and full-text articles for eligibility, with disagreements resolved by a third reviewer. Data on study characteristics, participant demographics, and etiological factors were extracted using a standardized form. Descriptive analysis summarized the etiology of acute pancreatitis in Saudi Arabia based on the extracted data. Out of the 58 studies retrieved for screening, 10 studies were included in the final systematic review, and most of them were done in the Riyadh region. The sum of the sample size was 1,695 participants. In Saudi Arabia, the most prevalent cause of acute pancreatitis is biliary stones. The average mortality rate of acute pancreatitis in reported studies is 2.2%. In conclusion, biliary and idiopathic causes are the most frequent etiologies of AP in some different regions of Saudi Arabia, acute peripancreatic fluid collections and pancreatic pseudocysts are the two most commonly reported complications associated with AP, and the mortality rate of AP in Saudi Arabia may be higher compared to developed countries.
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Affiliation(s)
- Ahmed A Almohammadi
- Preventive Medicine and Public Health, Saudi Commission for Health Specialties, Medina, SAU
| | - Owais H Aljafri
- Preventive Medicine and Public Health, Saudi Commission for Health Specialties, Medina, SAU
| | - Hossam H Esawi
- Preventive Medicine and Public Health, Saudi Commission for Health Specialties, Medina, SAU
| | - Anas A Alzhrani
- Preventive Medicine and Public Health, Saudi Commission for Health Specialties, Medina, SAU
| | - Muteb S Alharbi
- Preventive Medicine and Public Health, Saudi Commission for Health Specialties, Medina, SAU
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