P0013 - Patient Factors Associated With Oral Feeding Within 1 Day of Admission for Acute Pancreatitis in a Large Multihospital Health System

Sunday, October 24, 2021

3:30 PM – 7:00 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Aaron M. Hein, MD

Duke University Medical Center
Durham, NC, United States

Aaron M. Hein, MD¹, Neesha Nama, MD¹, Sandra Au, BS², Jared N. Gloria, MD³, Courtney M. Richman, MD¹, Alice Parish, MSPH⁴, Donna Niedzwiecki, PhD², Alyson McGhan Johnson, MD¹, Joshua P. Spaete, MD¹, Darshan J. Kothari, MD¹
¹Duke University Medical Center, Durham, NC; ²Duke University School of Medicine, Durham, NC; ³Emory University Hospital, Atlanta, GA; ⁴Duke University, Durham, NC

Introduction: Acute pancreatitis (AP) is a common admission diagnosis with significant morbidity and mortality. Guidelines recommend resuming oral feeding at 24 hours in patients admitted with AP to reduce infectious complications. We characterized adherence rates to this hospital-based quality measure and identified factors associated with adherence to inform quality improvement measures.

Methods: A retrospective review of patients admitted with AP to a large multihospital health system between 10/2019-10/2020 was performed. Adult patients meeting the revised Atlanta classification (RAC) were included. Exclusion criteria were age < 18 years, admission to an outside hospital >24 hours, concurrent diagnosis of pancreatic cancer, recent history of pancreatic surgery or admission for AP within 30 days. Severity categorization also followed RAC. Our primary outcome was the percentage of patients receiving oral feeding within 1 day of admission, calculated as the difference between the date of initial oral diet order and the admission date. Associations between patient variables and metric adherence were assessed using Chi-square, t, and Wilcoxon rank sum tests.

Results: In our study, 309 met inclusion criteria of which about half were male and white. The median length of stay (LOS) for all patients was 4 days. 76% of patients received oral feeding within 1 day of admission with 63% of adherent patients starting a clear liquid diet. Common reasons cited for non-adherence were refractory symptoms (56%), critical illness (19%), or periprocedural indications (18%). LOS was significantly shorter in patients who were adherent to the guideline. A significantly greater proportion of patients in the non-adherent group met criteria for moderately-severe or severe AP, had pancreatic fluid collections and/or necrosis, were admitted to the intensive care unit and were more likely to have sought care at the community hospitals (p≤0.02) (Table).

Discussion: In a multihospital cohort, 24% of patients with AP did not receive oral feeding within 1 day of admission. Early oral feeding was associated with significantly shorter LOS, university hospital admission and mild AP. While prospective studies are needed to validate these data, quality improvement interventions can be designed to target barriers to adherence and improve health-system quality metric performance.

	Non-adherence (N=73)	Adherence (N=230)	P-value
Patient Demographics
Age (Median, IQR)	50 (43, 62)	56 (40, 69)	0.3392

Gender			0.725¹
Male	39 (54.2%)	130 (56.5%)
Female	33 (45.8%)	100 (43.5%)

Race/Ethnicity			0.773¹
Asian	2 (2.7%)	4 (1.8%)
Black or African American	20 (27.4%)	80 (35.1%)
Hispanic or Latino	10 (13.7%)	26 (11.4%)
White	40 (54.8%)	116 (50.9%)
Other	1 (1.4%)	2 (0.9%)

Body Mass Index (Median, IQR)	27.8 (24.7, 33.3)	29.3 (24.8, 33.7)	0.750²

Patient Clinical Characteristics
Charlson Comorbidity Index, Points (Median, IQR)	2.0 (0.0, 4.0)	2.0 (1.0, 4.0)	0.156²

History of Acute Pancreatitis			0.132¹
Yes	18 (25.0%)	39 (17.0%)
No	54 (75.0%)	190 (83.0%)

Hospital Length of Stay (Median, IQR)	6.0 (4.0, 10.0)	4.0 (3.0, 6.0)	< 0.001³

Hospital Location			0.001¹
University Hospital	19 (26.0%)	112 (48.7%)
Community Hospital 1	26 (35.6%)	74 (32.2%)
Community Hospital 2	28 (38.4%)	44 (19.1%)

Admitting Specialty			0.141¹
Medicine	65 (89.0%)	192 (83.8%)
Surgery	4 (5.5%)	30 (13.1%)
Other	4 (5.5%)	7 (3.1%)

Etiology of Pancreatitis
Biliary/Gallstones	26	81	0.950¹
Alcohol Use	24	58	0.199¹
Hypertriglyceridemia	9	16	0.146¹
Post-procedural	0	2	0.424¹
Drug-related	3	22	0.140¹
Idiopathic	12	49	0.366¹
Other	8	19	0.481¹

Severity of Pancreatitis			0.005¹
Mild	51 (69.9%)	191 (84.1%)
Moderately-Severe	12 (16.4%)	27 (11.9%)
Severe	10 (13.7%)	9 (4.0%)

Presence of Pancreatic Necrosis or Fluid Collection*			0.013¹
Yes	16 (25.4%)	20 (12.0%)
No	47 (74.6%)	146 (88.0%)

Type of Initial Oral Feeding			0.039¹
Clear liquid diet	41 (60.3%)	144 (62.9%)
Full liquid diet	9 (13.2%)	12 (5.2%)
Solid diet	13 (19.1%)	66 (28.8%)
Enteral feeding	5 (7.4%)	6 (2.6%)
Other	0 (0.0%)	1 (0.4%)

ICU Admission			0.002¹
Yes	16 (21.9%)	19 (8.3%)
No	57 (78.1%)	210 (91.7%)
ICU Length of Stay (Median, IQR)	5.0 (3.0, 7.5)	3.0 (2.0, 8.0)	0.404²
¹Chi-Square ²Equal Variance T-Test ³Wilcoxon rank sum

Table: Table 1. Characteristics of Patients with Acute Pancreatitis Based on Adherence to Early Oral Feeding Quality Metric. Demographic and clinical characteristics were collected for patients admitted with acute pancreatitis and stratified based on adherence or non-adherence to initiation of oral nutrition within 1 day of admission. Counts and column percentages are shown unless otherwise specified; percentages not reported for etiology of pancreatitis as some participants had multifactorial etiologies recorded. 6 patients had data missing for adherence to the quality metric and are not included. Counts that do not equal to total cohort for each measure reflect missing or unavailable data. *Majority of missing data attributable to lack of available imaging during admission. Abbreviations: Interquartile range (IQR), intensive care unit (ICU).

Disclosures:

Aaron Hein indicated no relevant financial relationships.

Neesha Nama indicated no relevant financial relationships.

Sandra Au indicated no relevant financial relationships.

Jared Gloria indicated no relevant financial relationships.

Courtney Richman indicated no relevant financial relationships.

Alice Parish indicated no relevant financial relationships.

Donna Niedzwiecki indicated no relevant financial relationships.

Alyson McGhan Johnson indicated no relevant financial relationships.

Joshua Spaete indicated no relevant financial relationships.

Darshan Kothari indicated no relevant financial relationships.

Aaron M. Hein, MD¹, Neesha Nama, MD¹, Sandra Au, BS², Jared N. Gloria, MD³, Courtney M. Richman, MD¹, Alice Parish, MSPH⁴, Donna Niedzwiecki, PhD², Alyson McGhan Johnson, MD¹, Joshua P. Spaete, MD¹, Darshan J. Kothari, MD¹. P0013 - Patient Factors Associated With Oral Feeding Within 1 Day of Admission for Acute Pancreatitis in a Large Multihospital Health System, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.