Endoscopic intervention and cholecystectomy in pregnant women with acute biliary pancreatitis decreases early readmissions.

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Endoscopic intervention and cholecystectomy in pregnant women with acute biliary pancreatitis decreases early readmissions.

Gastrointest Endosc. 2018 Nov 29;:

Authors: Luthra AK, Patel K, Li F, Groce JR, Lara L, Strobel S, Hosmer A, Hinton A, Conwell DL, Krishna SG

Abstract
BACKGROUND AND AIMS: Acute biliary pancreatitis (ABP) is associated with increased rates of morbidity in pregnancy. Because there is a paucity of population-based studies evaluating ABP in pregnancy, we sought to investigate clinical outcomes in hospitalized pregnant women on a national level.
METHODS: Using the Nationwide Readmission Database (2011-2014), we identified all women (age ≥18 years) with an index admission for ABP in the United States. Multivariate and propensity-score matched analyses were performed to evaluate the impact of pregnancy on the clinical outcomes of early readmission and severe acute pancreatitis (SAP) in ABP.
RESULTS: There were 7,787 hospitalizations for ABP in pregnant women during the study period. The rate of 30-day readmission was 16.26%; 57% of these early readmissions were due to adverse events of ABP. Compared with nonpregnant women with ABP, ERCP (21.1% vs 25.2%, p<0.001) and cholecystectomy (52.8% vs 55.2%, p = 0.02) were less frequently performed during pregnancy. Propensity-score matched analysis revealed an increased risk of 30-day readmissions in pregnancy (OR, 1.96; 95% CI, 1.67 -2.30) whereas there was no difference in the risk of SAP (OR, 1.09; 95% CI, 0.76 - 1.57). Multivariate analysis demonstrated that weekend admission (OR, 1.40; 95% CI, 1.10 -1.79) and >1 week of hospitalization (OR, 1.75; 95% CI, 1.24 - 2.48) increased the risk of 30-day readmission, whereas ERCP (OR, 0.40; 95% CI, 0.27 - 0.57) and cholecystectomy (OR, 0.13; 95% CI, 0.10-0.18) reduced the odds of early readmission in pregnancy.
CONCLUSIONS: Pregnant women with ABP less frequently undergo timely endoscopic biliary decompression and cholecystectomy. These modifiable factors can potentially lower early readmissions in pregnant women.

PMID: 30503844 [PubMed - as supplied by publisher]

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