Opioid treatment and hypoalbuminemia are associated with increased hospitalisation rates in chronic pancreatitis outpatients |
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| Affiliation: | 1. Centre for Pancreatic Diseases, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark;2. Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark;3. Department of Radiology, Aalborg University Hospital, Aalborg, Denmark;4. Department of Clinical Medicine, Aalborg University, Aalborg, Denmark;1. Middle East Sustainable Livestock, Biotechnology and Agro-Ecology Research and Development Centre, Zirve University, 27260 Gaziantep, Turkey;2. Department of Animal Science, Faculty of Agriculture, Ondokuz Mayıs University, Samsun, Turkey;1. Department of HPB Surgery, Beaujon Hospital, 100 boulevard Général Leclerc, 92110 Clichy, France;2. Department of Pathology, Beaujon Hospital, 100 boulevard Général Leclerc, 92110 Clichy, France;3. Department of Hepatology, Beaujon Hospital, 100 boulevard Général Leclerc, 92110 Clichy, France;1. Department of Surgery, Keio University School of Medicine, Tokyo, Japan;2. Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan;3. Department of Transplantation and Pediatric Surgery, Kumamoto University, Kumamoto, Japan;4. Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare School of Medicine, Chiba, Japan;1. Division of Cardiothoracic Surgery, Department of Surgery, Washington University, St Louis, Missouri;2. Department of Surgery, Washington University, St Louis, Missouri;3. Division of Pulmonology and Critical Care, Washington University, St Louis, Missouri;4. Mid-America Transplant, St Louis, Missouri;5. Barnes-Jewish Hospital, St Louis, Missouri;1. Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea;2. Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea;3. Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea |
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| Abstract: | Background/objectivesChronic pancreatitis (CP) is a complex and debilitating disease with high resource utilisation. Prospective data on hospital admission rates and associated risk factors are scarce. We investigated hospitalisation rates, causes of hospitalisations and associated risk factors in CP outpatients.MethodsThis was a prospective cohort study comprising 170 patients with CP. The primary outcome was time to first pancreatitis related hospitalisation and secondary outcomes were the annual hospitalisation frequency (hospitalisation burden) and causes of hospitalisations. A number of clinical and demographic parameters, including pain pattern and severity, opioid use and parameters related to the nutritional state, were analysed for their association with hospitalisation rates.ResultsOf the 170 patients, 57 (33.5%) were hospitalised during the follow-up period (median 11.4 months [IQR 3.8–26.4]). The cumulative hospitalisation incidence was 7.6% (95% CI; 4.5–12.2) after 30 days and 28.8% (95% CI; 22.2–35.7) after 1 year. Eighteen of the hospitalised patients (32%) had three or more admissions per year. High dose opioid treatment (>100 mg per day) (Hazard Ratio 3.1 [95% CI; 1.1–8.5]; P = 0.03) and hypoalbuminemia (<36 g/l) (Hazard Ratio 3.8 [95% CI; 2.0–7.8]; P < 0.001) were identified as independent risk factors for hospitalisation. The most frequent causes of hospitalisations were pain exacerbation (40%) and common bile duct stenosis (28%).ConclusionsOne-third of CP outpatients account for the majority of hospital admissions and associated risk factors are high dose opioid treatment and hypoalbuminemia. This information should be implemented in outpatient monitoring strategies to identify risk patients and improve treatment. |
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| Keywords: | Hospitalisation rate Risk factors Chronic pancreatitis Pain Hypoalbuminemia Malnutrition Opioid treatment |
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