E0002 - Serial Lipase Measurement Prolongs Hospitalization in Patients With Acute Pancreatitis

Samantha Magier, MD, ME¹, Melanie Pascal, MD², Ahmad Nawaz, MD¹, Thiruvengadam Muniraj, MD, PhD¹, Kenneth W. Hung, MD, MS^1
1Yale University School of Medicine, New Haven, CT; ²Dartmouth-Hitchcock Medical Center, Lebanon, NH

Introduction: Acute pancreatitis (AP) is one of the most common gastrointestinal indications for inpatient admission. Serial serum lipase measurement has negligible value in gauging clinical course or prognosis in AP. The American Society for Clinical Pathology recommends against routine repeat lipase measurement after an initial diagnosis of AP. However, repeat serum lipase testing is routinely performed with combined direct and indirect costs attributed to testing alone exceeding $30 million nationally. We sought to understand the frequency of serial lipase measurement, assess the impact of repeated lipase measurement on length of hospitalization, and identify factors associated with repeat lipase measurement.

Methods: We retrospectively studied adults ≥ 18 years of age with a diagnosis of AP based on ICD-10 code and/or serum lipase greater than three times the upper limit of normal at Yale New Haven Hospital from March 2019-April 2021. Logistic regression was used to assess factors associated with multiple lipase measurements during the hospitalization. A linear regression model was built to identify the effect of repeat lipase on duration of hospitalization.

Results: A total of 1,569 hospitalizations with AP ICD-10 codes were identified, and 974 of these hospitalizations (62.1%) had more than one lipase measurement (Figure 1).

Female patients are more likely to have repeated lipase measurements during the hospitalization for AP. (P< 0.03). Patient age, race, and ethnicity were not associated with multiple lipase measurements during a hospitalization.

Duration of hospitalization for AP increased with advanced age. The length of stay (LOS) was significantly longer among patients who stayed in ICU (mean 11.5 days, 95% CI 10.1-12.9) vs. non-ICU (mean 4.9 days, 95% CI 4.5-5.3). Even after controlling for ICU stay and age, the LOS was significantly longer among the patients who received multiple vs. single lipase measurements. (p < 0.01) (Table 1).

Discussion: More than 2/3 of the patients hospitalized with AP had repeat lipase measurements. Serial lipase measurement in AP is associated with significantly prolonged LOS. Future studies should evaluate provider and hospitalization factors associated with serial lipase measurement, and quality improvement initiatives are needed to reduce unnecessary repeat lipase measurements.




Disclosures:


Samantha Magier, MD, ME¹, Melanie Pascal, MD², Ahmad Nawaz, MD¹, Thiruvengadam Muniraj, MD, PhD¹, Kenneth W. Hung, MD, MS¹. E0002 - Serial Lipase Measurement Prolongs Hospitalization in Patients With Acute Pancreatitis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.