Association between acute peripancreatic fluid collections and early readmission in acute pancreatitis:A propensity-matched analysis

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 andχ2 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.

Acute pancreatitis:A pictorial review of early pancreatic fluid collections

Acute pancreatitis is a common acute inflammatory disease involving the pancreas and peripancreatic tissues or remote organs.The revised Atlanta classification 2012 of acute pancreatitis divides patients into mild,moderately severe and severe groups.Major changes of the classification include acute fluid collection terminology.However,some inappropriate terms of the radiological diagnosis reports in the daily clinical work or available literature may still be found.The aim of this review article is:to present an image-rich overview of different morphologic characteristics of the early-stage(within 4 wk after symptom onset)local complications associated with acute pancreatitis by computed tomography or magnetic resonance imaging;to clarify confusing imaging concepts for pancreatic fluid collections and underline standardised reporting nomenclature;to assist communication among treating physicians;and to facilitate the implications for clinical management decision-making.

Imaging lexicon for acute pancreatitis:2012 Atlanta Classification revisited

The original 1992 Atlanta Classification Systemfor acute pancreatitis was revised in 2012 by the Atlanta Working Group,assisted by various national and international societies,through web-based consensus.This revised classification identifies two phases of acute pancreatitis:early and late.Acute pancreatitis can be either oedematous interstitial pancreatitis or necrotizing pancreatitis.Severity of the disease is categorized into three levels:mild,moderately severe and severe,depending upon organ failure and local/systemic complications.According to the type of pancreatitis,collections are further divided into acute peripancreatic fluid collection,pseudocyst,acute necrotic collection,and walled-off necrosis.Insight into the revised terminology is essential for accurate communication of imaging findings.In this review article,we will summarize the updated nomenclature and illustrate corresponding imaging findings using examples.