Predictors of 30-day unplanned readmission in necrotizing pancreatitis - A 12 year experience from a tertiary care center.

Background and aim: Hospital readmission rate is a key hospital metric and represents a substantial burden to patients and the health care system. Necrotizing pancreatitis (NP) patients are at high risk for unplanned readmission. The aim of this study was to determine the incidence and predictors of 30-day unplanned readmission following index hospitalization for NP.

Methods: Adult NP patients who were managed at a single tertiary referral center between 2009-2022 were identified from a prospective database and categorized into 2 groups based on 30-day unplanned readmission following index hospitalization. Patients with no follow up, who died during index admission or within 30 days of discharge were excluded. Baseline data on admission including demographic, clinical, interventional, imaging, and discharge characteristics were compared. Multivariable analysis was completed to identify independent predictors of 30-day readmission.

Results: Among 505 patients with NP, [males - 347 (69%), median age- 50 years (IQR 37-63)] 191 (37.8%) had at least one unplanned readmission. The most common causes of readmission were abdominal pain (40%) and sepsis (27%). On multivariable analysis, independent predictors for early readmission were necrosis collection size ≥ 6 cm [aOR 1.91 (1.11-3.30), P<0.03], stay at outside hospital ≥ 14 days prior to transfer to tertiary center [aOR 2.89 (1.27-6.60), P<0.01], and need for percutaneous feeding tube at time of discharge [aOR 2.06 (1.01-4.21), P<0.05].

Conclusion: Readmission following NP is common and associated with greater mortality at 6 months. Expedited transfer to tertiary center for timely intervention, assiduous follow up of other high-risk patients (large collections and those who need enteral nutrition) could help avoid readmissions and optimize outcomes.