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Objectives: Acute pancreatitis (AP) guidelines for adult patients do not recommend routine prophylactic use of antibiotics because of no clinical merit on mortality, infectious complications, or length of stay. Although the mortality of pediatric AP is low, no studies have explored the rationale for antibiotic use in pediatric patients. The aim of this study was to evaluate the effects of early prophylactic antibiotics on length of stay and total costs in pediatric patients., Methods: Using the Japanese Diagnosis Procedure Combination database from 2010 to 2017, we used the stabilized inverse probability of treatment weighting method using propensity scores to balance the background characteristics in the antibiotics group and the control group, and compared length of stay and total costs between the groups., Results: We found significant differences between the antibiotics group (n = 652) and the control group (n = 467) in length of stay (11 days vs 9 days; percent difference, 15.4%; 95% confidence interval, 5.0%-26.8%) and total costs (US $4085 vs US $3648; percent difference, 19.8%; 95% confidence interval, 8.0%-32.9%)., Conclusions: Prophylactic antibiotics were associated with longer length of stay and higher total costs. Our results do not support routine use of prophylactic antibiotics in pediatric AP populations.

Objective: To evaluate the cumulative hospitalization cost differences between routine cholecystectomy and an observational approach during index hospitalization for pregnant patients., Methods: A retrospective cohort study of 1,245 pregnant women with biliary pancreatitis across the United States between 2010 and 2014 was performed using the Nationwide Readmissions Database. Cumulative costs and complications were compared between patients with and without cholecystectomy during both initial and subsequent hospitalizations., Results: Cholecystectomy was performed at index hospitalization in 374 patients (374/1,245 [30.0%]). Those who did not undergo index cholecystectomy experienced higher 30-day readmissions (33.7% vs 5.3%, P<.01), and 24.5% eventually underwent interval cholecystectomy. Incidence of bile duct injury was exceedingly low for cholecystectomies performed during either index or subsequent hospitalizations (4/548 [0.7%] vs 12/213 [1.5%], P<.01). No significant difference in risk of premature delivery and abortion was observed (13.3% vs 13.2%, P=.98). Most common diagnoses during readmission included cholelithiasis (44.9%), acute pancreatitis (29.9%), cholecystitis (19.9%), choledocholithiasis (12.8%), chronic pancreatitis (4.2%), cholangitis (1.7%), and pancreatic pseudocyst (1.1%). Patients who underwent cholecystectomy during the index hospitalization had the lowest average cumulative hospitalization episodes, followed by patients undergoing nonoperative management; patients undergoing interval cholecystectomy experienced the highest average hospitalization episodes (1.4 vs 1.7 vs 2.9 hospitalizations, P<.01 for both comparisons). Although initial hospitalization cost was higher for patients who underwent cholecystectomy during index admission, the cumulative hospitalization cost became lower when costs for subsequent readmissions were factored in., Conclusion: Early cholecystectomy should be considered in pregnant patients with biliary pancreatitis to reduce readmission costs, because there were no differences in postoperative outcomes.

Background: International guidelines recommend cholecystectomy within 2-4 weeks after mild to moderate acute biliary pancreatitis (ABP) to prevent recurrence. We aimed to investigate the compliance to guidelines concerning early cholecystectomy and the associated costs., Methods: Admissions for ABP 2011-2013 were retrospectively reviewed. Classification was made according to the revised Atlanta classification. Treatment, time to surgery and recurrence, as well as cost analysis for both in-hospital costs and loss of production (LOP) were performed., Results: In total, 254 patients were included. Some 202 of the ABP patients (80%) underwent definitive treatment during their first attack of ABP (68% cholecystectomy, 17% endoscopic retrograde cholangiopancreatography (ERCP), 15% both interventions) and 186 (73%) were treated within 1 month of discharge. Patients with ERCP alone were significantly older than cholecystectomy cases (p < .001), but no significant difference was observed between those who underwent ERCP or no treatment (p = .071). Mild ABP had intervention earlier (p < .001). In all, 52 patients (20%) had no intervention, out of which 15 were readmitted due to pancreatitis, compared to 3 patients of those treated at the initial admission (p < .001). The mean cost for hospital care and LOP in mild ABP was €6882 ± 3010 and €9580 ± 7047 for moderate ABP (p = .001). The cost for a recurrent episode was €16,412 ± 22,367., Conclusion: By improved compliance to current guidelines concerning the management of ABP, recurrence rate and associated costs can potentially be reduced.

Background: Inflammatory bowel disease (IBD) is associated with an increased risk of acute pancreatitis (AP). Our group examined differences in length of stay and costs for patients with IBD hospitalized for AP and the general population., Methods: Using the National Inpatient Sample, we examined all admissions during 2005 to 2011 with a primary diagnosis of AP and codiagnosis of IBD. Continuous variables were reported as mean ± SD and compared between IBD and controls. To compare the outcomes of interest, we conducted a 1:3 propensity score matching using a greedy algorithm based on age, gender, race, number of comorbidities, procedures, insurance, income quartiles, hospital bed size, hospital location, and teaching status. Statistical analyses were performed on SAS 9.3 (Cary, NC)., Results: There were 4291 hospitalizations of patients with IBD and AP over the 7-year period and 379,627 hospitalizations of patients without IBD and with AP. More patients with Crohn's disease developed AP than patients with ulcerative colitis (2145 versus 1219). The length of stay and costs for patients with AP and IBD were significantly higher than controls (5.7 days versus 4.9 days, P < 0.0001 and $29,724.89 versus $27,916.76, P < 0.0001). The percentage of patients with alcohol abuse was lower in patients with IBD than that of controls (11.8% versus 21.7%, P < 0.0001). However, the percentage of patients with IBD who were drug abusers was higher than controls (5.8% versus 4.3%, P < 0.0005)., Conclusions: Our study suggests that a codiagnosis of Crohn's disease or ulcerative colitis incurs a greater economic burden in patients with AP.

Objective: To estimate selected direct medical care costs of children with chronic pancreatitis (CP) and acute recurrent pancreatitis (ARP)., Methods: We performed a cross-sectional study of data from International Study Group of Pediatric Pancreatitis: In Search for a Cure (INSPPIRE), a multinational registry of children with ARP or CP. We determined health care utilization and estimated costs of hospitalizations, surgical and endoscopic procedures, and medications in our study population. Health care utilization data were obtained from all subjects enrolled in the study, and costs were calculated using national United States costs., Results: We included 224 subjects (median age 12.7 years), 42% of whom had CP. Mean number of hospitalizations, including for surgery and endoscopic retrograde cholangiopancreatography, was 2.3 per person per year, costing an estimated average $38,755 per person per year. Including outpatient medications, estimated total mean cost was $40,589 per person per year. Subjects using surgical procedures or endoscopic retrograde cholangiopancreatography incurred mean annual costs of $42,951 per person and $12,035 per person, respectively. Estimated annual costs of pancreatic enzyme replacement therapy, diabetic medications, and pain medications were $4114, $1761, and $614 per person, respectively. In an exploratory analysis, patients with the following characteristics appear to accrue higher costs than those without them: more frequent ARP attacks per year, reported constant or episodic pain, family history of pancreatic cancer, and use of pain medication., Conclusions: ARP and CP are uncommon childhood conditions. The severe burden of disease associated with these conditions and their chronicity results in high health care utilization and costs. Interventions that reduce the need for hospitalization could lower costs for these children and their families.

Objectives: The aim of the present study was to perform a comparative cost-effectiveness analysis of the different strategies used to prevent post-endoscopic retrograde cholangiopancreatography (ERCP) acute pancreatitis., Methods: We performed a cost-effectiveness decision analysis of 4 prophylactic strategies (nonsteroidal anti-inflammatory drugs or NSAIDs, pancreatic stent, stent plus rectal indomethacin, and no prophylaxis) in a simulated cohort of 300 patients during 1 year. Treatment effectiveness was defined as the number of patients who did not develop post-ERCP pancreatitis., Results: The baseline costs of each strategy were as follows: rectal NSAID $359,098, pancreatic stent $426,504, stent plus rectal indomethacin $479,153, and no prophylaxis $491,275. The mean number of cases developing post-ERCP pancreatitis was 16, 21, 23, and 37 for the strategies rectal NSAID, pancreatic stent, stent plus rectal indomethacin, and no prophylaxis, respectively. Taking rectal NSAID prophylaxis as the reference strategy, the odds ratio of an episode of post-ERCP acute pancreatitis after pancreatic stent placement was 1.33 (95% confidence interval [CI], 0.68-2.61); after stent plus indomethacin, it was 1.40 (95% CI, 0.72-2.73), and after no prophylaxis, it was 2.49 (95% CI, 1.35-4.59)., Conclusions: Rectal NSAID administration proved to be the most cost-effective prophylactic strategy used to prevent post-ERCP pancreatitis. The strategy of no prophylaxis for this complication should be avoided.

OBJECTIVE. Severity of acute pancreatitis (AP) can vary from a mild to a fulminant disease with high morbidity and mortality. Cost analysis has, however, hitherto been sparse. The aim of this study was to calculate the cost of acute pancreatitis, both including hospital costs and costs due to loss of production. MATERIAL AND METHODS. All adult patients treated at Skane University Hospital, Lund, during 2009-2010, were included. A severity grading was conducted and cost analysis was performed on an individual basis. RESULTS. Two hundred and fifty-two patients with altogether 307 admissions were identified. Mean age was 60 ± 19 years, and 121 patients (48%) were men. Severe AP (SAP) was diagnosed in 38 patients (12%). Thirteen patients (5%) died. Acute biliary pancreatitis was more costly than alcohol induced AP (p < 0.001). Total costs for treating mild AP (MAP) in patients ≤65 years old was lower (p = 0.001) and costs for SAP was higher (p = 0.024), as compared to older patients. The overall hospital cost and cost for loss of production was per person in mean €5,100 ± 2,400 for MAP and €28,200 ± 38,100 for SAP (p < 0.001). The costs for treating AP during the two-year-long study period were in mean €9,762 ± 19,778 per patient. Extrapolated to a national perspective, the annual financial burden for AP in Sweden would be €38,500,000; corresponding to €4,100,000 per million inhabitants. CONCLUSIONS. The costs of treating AP are high, especially in severe cases with a long ICU stay. These results highlight the need to optimize care and continue the identification and focus on SAP, in order to try to limit organ failure and infectious complications.

Objectives: To determine the direct medical costs of hospitalizations for acute pancreatitis in the United States and analyze the demographic characteristics of hospitalized patients., Methods: We searched the 2003 Healthcare Cost and Utilization Project-National Inpatient Sample for hospitalizations with a primary discharge diagnosis of acute pancreatitis. These were analyzed with respect to patient demographics, hospitalization rates, and total hospital charges and costs., Results: The estimated total cost for acute pancreatitis admissions was $2.2 billion (95% confidence interval [CI], 2.0 billion-2.3 billion) at a mean cost per hospitalization of $9870 (95% CI, 9300-10,400), and a mean cost per hospital day of $1670 (95% CI, 1620-1720). Costs per hospitalization were higher in urban hospitals, teaching hospitals, and for patients older than 65 years, based on a longer length of stay (LOS). The hospitalization rate was 0.52 per 1000 US population (95% CI, 0.48-0.56) for whites versus 0.76 per 1000 (95% CI, 0.65-0.87) for blacks., Conclusions: Acute pancreatitis hospitalizations cost more than $2 billion annually, and certain population groups (blacks and older patients) have disproportionately high hospitalization rates. This study highlights the need for prevention efforts, particularly targeting high-risk groups, and for further studies to identify cost effective treatment strategies for acute pancreatitis.

Background: In our cost-conscious health care system hospitals are finding that costs are as important as charges or reimbursements, especially as hospitals compete for managed care contracts. We have prospectively gathered cost data for more than 60 common operations performed at our institution over the last 3 years., Methods: Over a 25-month period, from January 1993 to February 1995, 30 pancreaticoduodenectomy procedures were performed for which cost data were available. Cases were divided according to diagnosis (neoplastic or benign) and were evaluated for complications which prolonged length of stay (LOS). Costs were analyzed by an item-by-item prospective micro-cost analysis technique. Items were grouped into two areas: operating room (OR) costs and hospital (ward) costs. OR costs included disposable equipment, nondisposable equipment, OR room, OR staff, postanesthesia care, and anesthesia costs. Ward costs included hospital room, pharmacy, and radiology costs., Results: OR costs for the 30 PD patients were similar and represented approximately 21% of total hospital costs. Of the 30 patients, complications resulting in a prolonged LOS occurred in 10 (33%): intra abdominal abscess in 3 (2 with pancreatic leaks), superficial marginal ulceration in 2, delayed return of gastrointestinal function in 2 (1 with pulmonary edema) and 1 each of bile leak, urosepsis, and chylous ascites. No cost differences were observed when comparing neoplasm versus chronic pancreatitis for all parameters. When comparing patients who had complications versus those who did not, however, there was a statistically significant cost difference for both hospital ward or total costs. Regardless of whether a PD was performed for neoplastic or benign disease, postoperative complications increased hospital ward costs by 76% due to increased LOS., Conclusions: This cost analysis study is an example of the methodology that would allow surgeons to investigate any common surgical procedure by first identifying areas of increased costs. This quantitative knowledge focuses the clinician on areas to improve quality which will then lower costs.