Trends and seasonality in hospitalizations for acute alcohol-related and biliary pancreatitis in the USA

Background:The incidence of acute pancreatitis(AP)is characterized by circannual and geographical variation.The aim of this study was to describe seasonal variation and trends in hospitalizations for AP in the USA with respect to AP etiology.Methods:The Nationwide Inpatient Sample data(2000–2016)from the Healthcare Cost and Utilization Project were used.The study population included all primary hospitalizations for AP.Biliary AP(BAP)and alcohol-induced AP(AAP)were distinguished by diagnostic and procedural ICD codes.Seasonal trend decomposition was performed.Results:There was a linear increase in annual incidence(per 100000 population)of AAP in the USA(from 17.0 in 2000 to 22.9 in 2016),while incidence of BAP,equaled 19.9 in 2000,peaked at 22.1 in 2006 and decreased to 17.4 in 2016.AP incidence demonstrated 18%annual incidence amplitude with summer peak and winter trough,more prominent in AAP.In 2016,within AAP,the highest incidence(per 100000 population)was noted among African-Americans(up to 50.4),followed by males aged 56–70 years(26.5)and Asians of low income(25.5);within BAP,above the average incidence was observed in Hispanic(up to 25.8)and Asian(up to 25.0)population.The most consistent and rapid increase in AP incidence was noted in males aged 56–70 years with an alcoholic etiology(average 6%annual incidence growth).Conclusions:The incidence and annual trends of AP vary significantly among demographic and socioeconomic groups and this knowledge may be useful for the planning of healthcare resources and identification of at-risk populations.

Detecting accidental punctures and lacerations during cholecystectomy in large datasets: Two methods of analysis

Background: After the Institute of Medicine(IOM) report To Err Is Human highlighted the impact of medical errors, the Agency for Healthcare Research and Quality(AHRQ) developed Patient-Safety Indicators(PSI) to improve quality by identifying potential inpatient safety problems. PSI-15 was created to study accidental punctures and lacerations(APL), but PSI-15 may underestimate APLs in populations of patients. This study compares PSI-15 with a more inclusive approach using a novel composite of secondary diagnostic and procedural codes. Methods: We used Nationwide Inpatient Sample(NIS) data(20 0 0–2012) from AHRQ’s Healthcare Cost and Utilization Project(H-CUP). We analyzed PSI-15-positive and-negative cholecystectomies. Cross tabulations identified codes that were significantly more frequent among PSI-15-positive cases; these secondary diagnostic and procedural codes were selected as candidate members of a composite marker(CM) of APL. We chose cholecystectomy patients for study because this is one of the most common general operations, and the large size of NIS allows for meaningful analysis of infrequent occurrences such as APL rates. Results: CM identified 1.13 times more APLs than did PSI-15. Patients with CM-detected APLs were significantly older and had worse mortality, comorbidities, lengths of stay, and charges than those detected with PSI-15. Further comparison of these two approaches revealed that time-series analysis for both APL markers revealed parallel trends, with inflections in 2007, and lowest APL rates in July. Conclusions: Although CM may yield more false positives, it appears more inclusive, identifying more clinically significant APLs, than PSI-15. Both measures presented similar trends over time, arguing against inflation in PSI-15 reporting. While arguably less specific, CM may increase sensitivity for detecting APL events during cholecystectomies. These results may inform the interpretation of other large population studies of APLs following abdominal operations.

Energetic etiologies of acute pancreatitis: A report of five cases

There are several common causes of acute pancreatitis, principally excessive alcohol intake and gallstones, and there are many rare causes. However, cases of pancreatitis still occur in the absence of any recognizable factors, and these cases of idiopathic pancreatitis suggest the presence of unrecognized etiologies. Five cases of acute pancreatitis in four patients came to attention due to a strong temporal association with exposure to nerve stimulators and energy drinks. Given that these cases of pancreatitis were otherwise unexplained, and given that these exposures were not clearly known to be associated with pancreatitis, we performed a search for precedent cases and for mechanistic bases. No clear precedent cases were found in Pub Med and only scant, weak precedent cases were found in public-health databases. However, there was a coherent body of intriguing literature in support of a mechanistic basis for these exposures playing a role in the etiology of pancreatitis.