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. 2017 Dec 7;8(12):e129.
doi: 10.1038/ctg.2017.55.

Which Patients with Mild Acute Pancreatitis Require Prolonged Hospitalization?

Harkirat Singh  1 , Amir Gougol  1 , Rawad Mounzer  2 , Dhiraj Yadav  1 , Efstratios Koutroumpakis  3 , Adam Slivka  1 , David C Whitcomb  1 , Georgios I Papachristou  1   4
Affiliations

Which Patients with Mild Acute Pancreatitis Require Prolonged Hospitalization?

Harkirat Singh et al. Clin Transl Gastroenterol. .

Abstract

Objectives: In our experience, a subset of mild acute pancreatitis (AP) patients, as defined by the Revised Atlanta Classification, has longer than expected hospitalization. Our aims are to report the prevalence of patients with mild AP who have a prolonged length of stay (LOS), evaluate the etiology, thoroughly phenotype, and finally compare this subset to those with expected LOS.

Methods: Patients admitted with AP from 2003 to 2015 were prospectively enrolled into this cohort study. LOS ≥8 days was considered as prolonged LOS. Data on demographics, clinical and laboratory variables, management, and outcomes was both prospectively and retrospectively collected. Continuous variables were compared using the nonparametric t-test (Wilcoxon's test) and categorical variables using the Pearson's χ2 test.

Results: Among 231 enrolled mild AP patients, 46 (20%) had a prolonged LOS (≥8 days). The main determinants of prolonged LOS included ongoing pancreatitis-related symptoms (n=31, 67.4%) and performance of cholecystectomy (n=11, 23.9%). When compared to patients with expected LOS (<8 days, n=185), patients with prolonged LOS due to ongoing symptoms (n=31) were more likely to have systemic inflammatory response syndrome at 48 h from admission (37% vs. 13.4%, P<0.001), a prolonged fasting period (6.6 vs. 2.8 days, P<0.001), and need for nutritional support (30% vs. 1.6%, P<0.001).

Conclusions: About 20% of patients with mild AP have a longer than expected hospital stay, mostly attributed to ongoing pancreatitis-related symptoms. An early decision (at 72 h) for enteral nutrition support in these patients needs to be explored so as to shorten hospitalization and reduce cost of care.

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Conflict of interest statement

Guarantor of the article: Georgios I. Papachristou, MD, PhD.

Specific author contributions: H.S., A.G., and G.I.P. were involved in the study concept/design, data acquisition, statistical analysis and interpretation, and drafting the manuscript. R.M. and E.K. were involved data acquisition and reviewing the manuscript. G.I.P., D.Y., A.S., and D.C.W. were involved in critical revision of manuscript and important intellectual content. All authors approved the final draft submitted.

Financial support: VA Merit Review Award—Predicting Persistent Organ Failure early in Acute Pancreatitis (I01 CX000272-01).

Potential competing interests: None.

Figures

Figure 1
Figure 1
Enrolled patients (pancreatitis severity based on Revised Atlanta Classification).
Figure 2
Figure 2
Length of stay plotted against number of patients.
Figure 3
Figure 3
Management algorithm for patients with mild acute pancreatitis.
See this image and copyright information in PMC

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