Predictors of hospital transfer and associated risks of mortality in acute pancreatitis

Background: There is limited research in prognosticators of hospital transfer in acute pancreatitis (AP). Hence, we sought to determine the predictors of hospital transfer from small/medium-sized hospitals and outcomes following transfer to large acute-care hospitals. Methods: Using the 2010-2013 Nationwide Inpatient Sample (NIS), patients >= 18 years of age with a primary diagnosis of AP were identified. Hospital size was classified using standard NIS Definitions. Multivariable analyses were performed for predictors of transfer-out from small/medium-sized hospitals and mortality in large acute-care hospitals. Results: Among 381,818 patients admitted with AP to small/medium-sized hospitals, 13,947 (4%) were transferred out to another acute-care hospital. Multivariable analysis revealed that older patients (OR = 1.04; 95%CI 1.03-1.06), men (OR = 1.15; 95%CI 1.06-1.24), lower income quartiles (OR = 1.54; 95% CI 1.35-1.76), admission to a non-teaching hospital (OR = 3.38; 95%CI 3.00-3.80), gallstone pancreatitis (OR = 3.32; 95%CI 2.90-3.79), pancreatic surgery (OR = 3.14; 95%CI 1.76-5.58), and severe AP (OR = 3.07; 95%CI 2.78-3.38) were predictors of transfer-out. ERCP (OR = 0.53; 95%CI 0.43-0.66) and cholecystectomy (OR = 0.14; 95%CI 0.12-0.18) were associated with decreased odds of transfer-out. Among 507,619 patients admitted with AP to large hospitals, 31,058 (6.1%) were transferred-in from other hospitals. The mortality rate for patients transferred-in was higher than those directly admitted (2.54% vs. 0.91%, p < 0.001). Multivariable analysis revealed that being transferred-in from other hospitals was an independent predictor of mortality (OR = 1.47; 95% CI 1.22-1.77). Conclusions: Patients with AP transferred into large acute-care hospitals had a higher mortality than those directly admitted likely secondary to more severe disease. Early implementation of published clinical guidelines, triage, and prompt transfer of high-risk patients may potentially offset these negative outcomes. (C) 2020 IAP and EPC. Published by Elsevier B.V. All rights reserved.

Automated summary

Limited research exists on prognosticators of hospital transfer in acute pancreatitis. Older age, male gender, lower income, gallstone pancreatitis, pancreatic surgery, and severe AP were predictors of transfer-out from small/medium-sized hospitals. Patients transferred into large acute-care hospitals had a higher mortality rate compared to those directly admitted, likely due to the severity of the disease.