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Quantifying the Impact of Acute Kidney Injury on Mortality, Morbidity and Resource Utilization in Acute Pancreatitis: A Decade of National Outcomes
Tu1398
or more modern chemotherapy. Further experience with more patients treated with prolonged modern chemotherapy may well change our findings so that they correlate to experience with patients with neoadjuvant therapy without celiac resection.
QUANTIFYING THE IMPACT OF ACUTE KIDNEY INJURY ON MORTALITY, MORBIDITY AND RESOURCE UTILIZATION IN ACUTE PANCREATITIS: A DECADE OF NATIONAL OUTCOMES Paul T. Kroner, Pichamol Jirapinyo, Marwan S. Abougergi, Thomas Clancy, Christopher C. Thompson Introduction Acute kidney injury (AKI) is a well-recognized negative prognostic factor for morbidity and mortality in acute pancreatitis (AP). Although several studies have documented a markedly increased incidence of AKI complicating AP, these studies are relatively small and include a limited number of outcomes, with mortality rates ranging from 5% to 80%. As such, quantification of AKI's effect on AP outcomes is challenging. The aim of this study was to assess the impact of AKI on mortality, morbidity and resource utilization among patients with AP over the past decade using a large national database. Materials and Methods This is a retrospective cohort study using the National Inpatient Sample, the largest publically available inpatient database in the USA, from 2004 to 2013. All patients with an ICD-9 CM code for a principal diagnosis of AP were included. There were no exclusion criteria. The primary outcome was in-hospital mortality. Secondary outcomes were morbidity measured by intensive care unit (ICU) admission, shock and multi- organ failure; resource utilization measured by abdominal CT, total parenteral nutrition (TPN) use, length of hospital stay (LOS) and total hospitalization costs. Patients who had a concomitant diagnosis of AKI were identified using the appropriate ICD-9 CM codes. Using multivariate regression analysis, odds ratios and means were adjusted for age, sex, race, income in the patient's zip code, Charlson Comorbidity Index, hospital region, urban location, size and teaching status. Results 2,690,774 patients with AP were included in the study, of which 182,448 (6.8%) had a diagnosis of AKI. Mean age was 52 years and 48% were female. For the primary outcome, mortality in patients with AP and AKI was significantly higher compared to patients without AKI (adjusted OR: 11.94, 95%CI: 11.01-12.95, p<0.01). For the secondary outcomes, patients with AKI displayed increased odds of shock, multi-organ failure and ICU admission when compared to patients without AKI. For resource utilization, patients with AKI had higher odds of TPN use and a longer mean LOS compared to patients without AKI. Total hospital costs were also significantly increased in patients with AKI. Table 1 displays all adjusted odds rations and means with p-values. Conclusion Patients with acute pancreatitis who develop acute kidney injury have an almost 12-fold greater in-hospital mortality rate compared with patients without acute kidney injury. In addition, acute kidney injury development is associated with significant morbidity in acute pancreatitis, as measured by greater rates of shock, ICU admission and multi-organ failure. Finally, acute kidney injury in acute pancreatitis has a profound effect on resource utilization, with increased TPN use as well as longer length of stay and higher total hospitalization costs. Table 1 - Adjusted means and odds ratios for patients with acute pancreatitis with and without acute kidney injury
Figure 1. Overall survival curve. "High indicates major response and "low" moderate and poor response.
Tu1400
Background: Delayed gastric emptying (DGE) is a common and frustrating complication of pancreaticoduodenectomy (PD). Postoperative DGE may require prolonged nasogastric decompression which causes patient discomfort, increases risk for aspiration events, and prolongs hospital stay. Since the pathophysiology of DGE is unclear, there is no way to predict in which patients DGE is likely to occur. The purpose of this study is to assess whether continuous monitoring of postoperative gastrointestinal motor activity after PD is reproducible and can identify patients that may be at risk for developing DGE. Methods: Thirty patients were enrolled in this trial between April and November 2016. After PD, three battery-operated wireless patches that acquire myoelectrical signals from the stomach, small intestine, and colon were placed on the anterior abdomen immediately following surgery. The system transmits signal data by Bluetooth to a programmed iPod Touch that also has a user interface that allows the patient to enter clinical parameters. Post-processing of data included removal of large amplitude artifacts and band-pass filtering, followed by Fourier transformation to frequency space over selected time subintervals. Patients were divided into two groups: EARLY and LATE, by length of stay (LOS) < 9 days vs ≥ 9 days (cut off based on our institutional median LOS after PD). Results: Of the 30 patients enrolled, 2 were excluded for technically inadequate tracings. There were 11 patients in the EARLY and 17 in the LATE group (LOS 7 vs 11 days, respectively, p<0.05). Nasogastric insertion was required in 5 patients in the LATE group for a median of 4 days compared to no patients in the EARLY group (p=0.05). Tolerance of solid food was noted by a median of 6 days in the EARLY and 8 days in the LATE group (p<0.05). Gastric myoelectical activity was notably higher in the EARLY group versus the LATE group through the first three days after PD. Figure 1 demonstrates the waterfall plot of a representative patient in the EARLY (Fig 1A) and LATE (Fig 1B) groups demonstrating the first three days of the frequency spectrum computed every 30 minutes and staggered as a function of time. Figure 2 shows the average activity computed from days 1 through 3 for the two groups. Conclusions: Measurement of gastric myoelectrical activity in the postoperative period after PD is feasible and can distinguish those patients with longer LOS. Further validation work is needed to develop an accurately predictive algorithm for DGE. This promising technology may allow identification of patients at risk for DGE and help guide timing of oral intake by gastric "readiness."
Tu1399 PATHOLOGIC RESPONSE TO CHEMOTHERAPY MAY NOT CORRELATE WITH SURVIVAL IN PATIENTS WITH COMBINED PANCREATIC AND CELIAC RESECTION AFTER NEOADJUVANT THERAPY Andrea Porpiglia, Senthil Jayarajan, Harry Cooper, Sanjay S. Reddy, John P. Hoffman, Andreas Karachristos Introduction: Major pathologic response after neoadjuvant therapy has been associated with improved outcomes in patients with pancreatic cancer. The purpose of this study is to analyze the survival of patients with combined pancreatic and celiac resection after neoadjuvant therapy according to pathologic response. Methods: We reviewed a prospective database of patients with pancreatic adenocarcinoma and celiac axis involvement treated with chemoradiation and chemotherapy followed by resection from 1995-2014. Histopathology was performed in all specimens to identify major response to neoadjuvant therapy as defined by fibrosis ≥95%. Survival curves were generated using Kaplan-Meier method and compared with the log-rank test. Survival was calculated from the day of diagnosis. Results: The study included 14 consecutive patients from 1995 to 2014 operated by the authors. One patient expired two months after resection and was excluded from the analysis. All received neoadjuvant radiation with concurrent Gemcitabine, 5FU or Xeloda. Four patients received neoadjuvant gemcitabine- based chemotherapy followed by chemoradiation. There were 7 women. Four patients had Whipple procedures, 3 had total pancreatectomies and 7 had subtotal pancreatectomies. Nine patients needed liver revascularization. Three patients had fibrosis ≥ 95%. Median survival from diagnosis for the entire cohort was 25 months. There was no difference found in disease free or overall survival between groups. Overall survival is shown in the figure. Conclusions: Major pathologic response to preoperative therapy does not correlate with survival in patients with pancreatic adenocarcinoma with involvement and resection of the celiac axis. The results may well have been influenced by the small size of our cohort. Furthermore the majority of patients did not receive preoperative chemotherapy
S-1293
SSAT Abstracts
SSAT Abstracts
MONITORING OF GASTRIC MYOELECTRIC ACTIVITY AFTER PANCREATICODUODENECTOMY Monica M. Dua, Lavina Malhotra, Anand R. Navalgund, Steve Axelrod, George Triadafilopoulos, Brendan Visser
or more modern chemotherapy. Further experience with more patients treated with prolonged modern chemotherapy may well change our findings so that they correlate to experience with patients with neoadjuvant therapy without celiac resection.
QUANTIFYING THE IMPACT OF ACUTE KIDNEY INJURY ON MORTALITY, MORBIDITY AND RESOURCE UTILIZATION IN ACUTE PANCREATITIS: A DECADE OF NATIONAL OUTCOMES Paul T. Kroner, Pichamol Jirapinyo, Marwan S. Abougergi, Thomas Clancy, Christopher C. Thompson Introduction Acute kidney injury (AKI) is a well-recognized negative prognostic factor for morbidity and mortality in acute pancreatitis (AP). Although several studies have documented a markedly increased incidence of AKI complicating AP, these studies are relatively small and include a limited number of outcomes, with mortality rates ranging from 5% to 80%. As such, quantification of AKI's effect on AP outcomes is challenging. The aim of this study was to assess the impact of AKI on mortality, morbidity and resource utilization among patients with AP over the past decade using a large national database. Materials and Methods This is a retrospective cohort study using the National Inpatient Sample, the largest publically available inpatient database in the USA, from 2004 to 2013. All patients with an ICD-9 CM code for a principal diagnosis of AP were included. There were no exclusion criteria. The primary outcome was in-hospital mortality. Secondary outcomes were morbidity measured by intensive care unit (ICU) admission, shock and multi- organ failure; resource utilization measured by abdominal CT, total parenteral nutrition (TPN) use, length of hospital stay (LOS) and total hospitalization costs. Patients who had a concomitant diagnosis of AKI were identified using the appropriate ICD-9 CM codes. Using multivariate regression analysis, odds ratios and means were adjusted for age, sex, race, income in the patient's zip code, Charlson Comorbidity Index, hospital region, urban location, size and teaching status. Results 2,690,774 patients with AP were included in the study, of which 182,448 (6.8%) had a diagnosis of AKI. Mean age was 52 years and 48% were female. For the primary outcome, mortality in patients with AP and AKI was significantly higher compared to patients without AKI (adjusted OR: 11.94, 95%CI: 11.01-12.95, p<0.01). For the secondary outcomes, patients with AKI displayed increased odds of shock, multi-organ failure and ICU admission when compared to patients without AKI. For resource utilization, patients with AKI had higher odds of TPN use and a longer mean LOS compared to patients without AKI. Total hospital costs were also significantly increased in patients with AKI. Table 1 displays all adjusted odds rations and means with p-values. Conclusion Patients with acute pancreatitis who develop acute kidney injury have an almost 12-fold greater in-hospital mortality rate compared with patients without acute kidney injury. In addition, acute kidney injury development is associated with significant morbidity in acute pancreatitis, as measured by greater rates of shock, ICU admission and multi-organ failure. Finally, acute kidney injury in acute pancreatitis has a profound effect on resource utilization, with increased TPN use as well as longer length of stay and higher total hospitalization costs. Table 1 - Adjusted means and odds ratios for patients with acute pancreatitis with and without acute kidney injury
Figure 1. Overall survival curve. "High indicates major response and "low" moderate and poor response.
Tu1400
Background: Delayed gastric emptying (DGE) is a common and frustrating complication of pancreaticoduodenectomy (PD). Postoperative DGE may require prolonged nasogastric decompression which causes patient discomfort, increases risk for aspiration events, and prolongs hospital stay. Since the pathophysiology of DGE is unclear, there is no way to predict in which patients DGE is likely to occur. The purpose of this study is to assess whether continuous monitoring of postoperative gastrointestinal motor activity after PD is reproducible and can identify patients that may be at risk for developing DGE. Methods: Thirty patients were enrolled in this trial between April and November 2016. After PD, three battery-operated wireless patches that acquire myoelectrical signals from the stomach, small intestine, and colon were placed on the anterior abdomen immediately following surgery. The system transmits signal data by Bluetooth to a programmed iPod Touch that also has a user interface that allows the patient to enter clinical parameters. Post-processing of data included removal of large amplitude artifacts and band-pass filtering, followed by Fourier transformation to frequency space over selected time subintervals. Patients were divided into two groups: EARLY and LATE, by length of stay (LOS) < 9 days vs ≥ 9 days (cut off based on our institutional median LOS after PD). Results: Of the 30 patients enrolled, 2 were excluded for technically inadequate tracings. There were 11 patients in the EARLY and 17 in the LATE group (LOS 7 vs 11 days, respectively, p<0.05). Nasogastric insertion was required in 5 patients in the LATE group for a median of 4 days compared to no patients in the EARLY group (p=0.05). Tolerance of solid food was noted by a median of 6 days in the EARLY and 8 days in the LATE group (p<0.05). Gastric myoelectical activity was notably higher in the EARLY group versus the LATE group through the first three days after PD. Figure 1 demonstrates the waterfall plot of a representative patient in the EARLY (Fig 1A) and LATE (Fig 1B) groups demonstrating the first three days of the frequency spectrum computed every 30 minutes and staggered as a function of time. Figure 2 shows the average activity computed from days 1 through 3 for the two groups. Conclusions: Measurement of gastric myoelectrical activity in the postoperative period after PD is feasible and can distinguish those patients with longer LOS. Further validation work is needed to develop an accurately predictive algorithm for DGE. This promising technology may allow identification of patients at risk for DGE and help guide timing of oral intake by gastric "readiness."
Tu1399 PATHOLOGIC RESPONSE TO CHEMOTHERAPY MAY NOT CORRELATE WITH SURVIVAL IN PATIENTS WITH COMBINED PANCREATIC AND CELIAC RESECTION AFTER NEOADJUVANT THERAPY Andrea Porpiglia, Senthil Jayarajan, Harry Cooper, Sanjay S. Reddy, John P. Hoffman, Andreas Karachristos Introduction: Major pathologic response after neoadjuvant therapy has been associated with improved outcomes in patients with pancreatic cancer. The purpose of this study is to analyze the survival of patients with combined pancreatic and celiac resection after neoadjuvant therapy according to pathologic response. Methods: We reviewed a prospective database of patients with pancreatic adenocarcinoma and celiac axis involvement treated with chemoradiation and chemotherapy followed by resection from 1995-2014. Histopathology was performed in all specimens to identify major response to neoadjuvant therapy as defined by fibrosis ≥95%. Survival curves were generated using Kaplan-Meier method and compared with the log-rank test. Survival was calculated from the day of diagnosis. Results: The study included 14 consecutive patients from 1995 to 2014 operated by the authors. One patient expired two months after resection and was excluded from the analysis. All received neoadjuvant radiation with concurrent Gemcitabine, 5FU or Xeloda. Four patients received neoadjuvant gemcitabine- based chemotherapy followed by chemoradiation. There were 7 women. Four patients had Whipple procedures, 3 had total pancreatectomies and 7 had subtotal pancreatectomies. Nine patients needed liver revascularization. Three patients had fibrosis ≥ 95%. Median survival from diagnosis for the entire cohort was 25 months. There was no difference found in disease free or overall survival between groups. Overall survival is shown in the figure. Conclusions: Major pathologic response to preoperative therapy does not correlate with survival in patients with pancreatic adenocarcinoma with involvement and resection of the celiac axis. The results may well have been influenced by the small size of our cohort. Furthermore the majority of patients did not receive preoperative chemotherapy
S-1293
SSAT Abstracts
SSAT Abstracts
MONITORING OF GASTRIC MYOELECTRIC ACTIVITY AFTER PANCREATICODUODENECTOMY Monica M. Dua, Lavina Malhotra, Anand R. Navalgund, Steve Axelrod, George Triadafilopoulos, Brendan Visser