D0024 - Frailty Is Independently Associated With Higher Mortality and Readmissions in Hospitalized Patients With Acute Biliary Pancreatitis

Tuesday, October 25, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

Daryl Ramai, MD, MSc

University of Utah
Salt Lake City, UT

Daryl Ramai, MD, MSc¹, Joseph Heaton, MD², Ahmed Abomhya, MD², Saurabh Chandan, MD³, Banreet S. Dhindsa, MD⁴, Amaninder Dhaliwal, MD⁵, John Morris, MD⁶, Douglas G. Adler, MD, FACG⁷
¹University of Utah, Salt Lake City, UT; ²The Brooklyn Hospital Center, Brooklyn, NY; ³CHI Health Creighton School of Medicine, Omaha, NE; ⁴University of Nebraska Medical Center, Omaha, NE; ⁵McLeod Digestive Health Center, Florence, SC; ⁶University of Utah Health, Salt Lake City, UT; ⁷Centura Health-Porter Adventist Hospital, Salt Lake City, UT

Introduction: Acute pancreatitis is the most common gastrointestinal cause of hospital admissions in the United States of which biliary or gallstone disease is the most common inciting factor. Its costs has been estimated up to $2.6 billion per year. To this end, predictive models aimed at identifying patients at risk for worse outcomes and higher healthcare utilization is important. We conducted a nationally representative cohort study to estimate the independent effects of frailty on burden, costs, and causes for hospitalization in patients with acute biliary pancreatitis.

Methods: We analysed the Healthcare Cost and Utilization Project’s (HCUP) Nationwide Readmission Database from 2016 to 2019. Patients admitted with acute biliary pancreatitis were identified; those with concurrent cholangitis were excluded. Patients were categorized into two groups, frail and non-frail, based on Gilbert’s Hospital Frailty Risk Score. Categorical variables were described using proportions and compared with Chi-Squared Test. Continuous variables were presented as means and compared using the adjusted Wald test. Logistic and Cox regression models were used to predict the impact of frailty on 30-day readmission, length of stay, mortality, and total costs of hospitalization, respectively.

Results: 162,202 index hospitalizations with acute biliary pancreatitis without cholangitis were identified, of whom 59.2% (n=96,045) were female and 22.49% (n=36,475) were classified as frail. 39.17% (n=14,287) of frail patients were 75 years old or older. Readmissions within 30 days were higher among frail patients (12.58% vs 7.09%, P < 0.001) compared to non-frail patients respectively. Regression modelling showed that frail patients had higher odds of readmission (OR: 1.32; 95% CI 1.24-1.42, P < 0.001), longer lengths of stay (8.18 days vs 4.11 days), and higher average costs of hospitalization ($21,511 vs $12,261) compared to non-frail patients respectively. Cox regression analysis showed that frail patients had a higher risk of mortality (HR 5.43; 95% Cl 4.06 – 7.29, P< 0.001) compared to non-frail patients, respectively. Sepsis was the leading cause of readmission in frail patients.

Discussion: Frailty is independently associated with higher mortality and burden of healthcare utilization in patients with acute biliary pancreatitis without cholangitis; sepsis was the leading cause of readmission. We suggest using the Hospital Frailty Risk Score as part of the treatment algorithm in patients with acute biliary pancreatitis.

Figure: Rates of readmission in frail and non-frail patients

	Gilbert Frailty Risk Category
	Non-frail		Frail		Total		Obs	P-value
	%	CI	%	CI	%	CI
Age 75 and over
Under 75 Years Old	84.45	[84.13-84.77]	60.83	[60.04-61.61]	79.14	[78.81-79.47]	128,367	0.000
75 or Older	15.55	[15.23-15.87]	39.17	[38.39-39.96]	20.86	[20.53-21.19]	33,835
Total	100.00		100.00		100.00		162,202
Indicator of sex
Male	39.73	[39.31-40.14]	44.44	[43.67-45.21]	40.79	[40.42-41.16]	66,157	0.000
Female	60.27	[59.86-60.69]	55.56	[54.79-56.33]	59.21	[58.84-59.58]	96,045
Total	100.00		100.00		100.00		162,202
Died during hospitalization
Did not die	99.89	[99.86-99.91]	97.08	[96.80-97.34]	99.26	[99.19-99.32]	160,960	0.000
Died	0.11	[0.09-0.14]	2.92	[2.66-3.20]	0.74	[0.68-0.81]	1,205
Total	100.00		100.00		100.00		162,166
Calendar year
2016	25.44	[24.57-26.33]	24.29	[23.26-25.36]	25.18	[24.35-26.03]	40,847	0.011
2017	25.12	[24.29-25.97]	24.97	[24.00-25.97]	25.09	[24.30-25.89]	40,693
2018	25.02	[24.20-25.86]	25.07	[24.08-26.09]	25.03	[24.24-25.84]	40,601
2019	24.42	[23.57-25.29]	25.66	[24.64-26.71]	24.70	[23.88-25.53]	40,061
Total	100.00		100.00		100.00		162,202
Insurance Carrier, cleaned
Medicare	35.77	[35.30-36.24]	66.96	[66.15-67.76]	42.83	[42.38-43.28]	67,222	0.000
Medicaid	18.60	[18.12-19.09]	10.46	[9.97-10.98]	16.76	[16.33-17.19]	26,300
Private insurance	39.75	[39.23-40.27]	19.76	[19.09-20.45]	35.22	[34.77-35.68]	55,280
Self-pay	5.89	[5.64-6.15]	2.82	[2.56-3.10]	5.19	[4.98-5.42]	8,148
Total	100.00		100.00		100.00		156,950
Median household income
0-25th percentile	27.23	[26.45-28.03]	27.69	[26.71-28.69]	27.33	[26.58-28.10]	43,754	0.658
26th to 50th percentile (median)	27.76	[27.13-28.40]	27.45	[26.60-28.33]	27.69	[27.09-28.30]	44,323
51st to 75th percentile	25.54	[24.94-26.15]	25.30	[24.48-26.15]	25.49	[24.91-26.07]	40,799
76th to 100th percentile	19.47	[18.73-20.23]	19.55	[18.65-20.49]	19.49	[18.76-20.24]	31,196
Total	100.00		100.00		100.00		160,072
Bed size of hospital
Small	19.32	[18.61-20.05]	17.96	[17.06-18.89]	19.02	[18.33-19.73]	30,844	0.001
Medium	28.84	[28.01-29.69]	28.71	[27.70-29.74]	28.81	[28.01-29.63]	46,736
Large	51.83	[50.86-52.81]	53.33	[52.16-54.50]	52.17	[51.23-53.11]	84,622
Total	100.00		100.00		100.00		162,202
Hospital urban-rural designation
Large metropolitan areas with at least 1 million residents	53.85	[52.62-55.09]	54.10	[52.62-55.58]	53.91	[52.68-55.13]	87,443	0.000
Small metropolitan areas with less than 1 million residents	37.67	[36.45-38.90]	38.66	[37.20-40.13]	37.89	[36.68-39.11]	61,456
Micropolitan areas	6.53	[6.16-6.92]	5.75	[5.28-6.26]	6.35	[6.00-6.73]	10,308
Not metropolitan or micropolitan (non-urban residual)	1.95	[1.77-2.15]	1.49	[1.27-1.75]	1.85	[1.68-2.03]	2,996
Total	100.00		100.00		100.00		162,202
Teaching status of urban hospitals
Metropolitan non-teaching	24.78	[24.04-25.54]	24.24	[23.30-25.20]	24.66	[23.94-25.39]	39,993	0.000
Metropolitan teaching	66.74	[65.90-67.58]	68.52	[67.48-69.55]	67.14	[66.33-67.94]	108,906
Non-metropolitan hospital	8.48	[8.07-8.91]	7.24	[6.72-7.80]	8.20	[7.81-8.61]	13,304
Total	100.00		100.00		100.00		162,202
Patient Location: NCHS Urban-Rural Code
Central counties of metro areas of >=1 million population	25.56	[24.50-26.64]	23.61	[22.46-24.80]	25.12	[24.09-26.17]	40,654	0.000
Fringe counties of metro areas of >=1 million population	25.99	[24.95-27.05]	26.86	[25.63-28.12]	26.18	[25.16-27.23]	42,374
Counties in metro areas of 250,000-999,999 population	22.51	[21.50-23.56]	22.75	[21.61-23.93]	22.57	[21.57-23.59]	36,522
Counties in metro areas of 50,000-249,999 population	9.55	[8.97-10.16]	10.37	[9.66-11.12]	9.73	[9.16-10.33]	15,749
Micropolitan counties	9.12	[8.72-9.53]	9.05	[8.47-9.66]	9.10	[8.72-9.50]	14,731
Not metropolitan or micropolitan counties	7.28	[6.85-7.74]	7.37	[6.83-7.96]	7.30	[6.89-7.73]	11,817
Total	100.00		100.00		100.00		161,848
Admission day is a weekend
Admitted Monday-Friday	71.95	[71.56-72.33]	72.07	[71.38-72.75]	71.98	[71.65-72.30]	116,746	0.771
Admitted Saturday-Sunday	28.05	[27.67-28.44]	27.93	[27.25-28.62]	28.02	[27.70-28.35]	45,456
Total	100.00		100.00		100.00		162,202

Table: Study Characteristics

Disclosures:

Daryl Ramai indicated no relevant financial relationships.

Joseph Heaton indicated no relevant financial relationships.

Ahmed Abomhya indicated no relevant financial relationships.

Saurabh Chandan indicated no relevant financial relationships.

Banreet Dhindsa indicated no relevant financial relationships.

Amaninder Dhaliwal indicated no relevant financial relationships.

John Morris indicated no relevant financial relationships.

Douglas Adler: Boston Scientific – Consultant.

Daryl Ramai, MD, MSc¹, Joseph Heaton, MD², Ahmed Abomhya, MD², Saurabh Chandan, MD³, Banreet S. Dhindsa, MD⁴, Amaninder Dhaliwal, MD⁵, John Morris, MD⁶, Douglas G. Adler, MD, FACG⁷. D0024 - Frailty Is Independently Associated With Higher Mortality and Readmissions in Hospitalized Patients With Acute Biliary Pancreatitis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.