Published online Mar 7, 2019. doi: 10.3748/wjg.v25.i9.1080
Peer-review started: November 12, 2018
First decision: December 5, 2018
Revised: January 10, 2019
Accepted: January 26, 2019
Article in press: January 26, 2019
Published online: March 7, 2019
Literature has shown that use of imaging in patients with acute pancreatitis (AP) is rarely required for the diagnosis of AP and does not change the management or outcome in such patients. Guidelines suggest that diagnosis of AP can be done without imaging if the patient meets the clinical and biochemical diagnosis. Unwarranted imaging can lead to preventable radiation exposure, excessive healthcare resources, and unjustifiable healthcare costs.
Reducing healthcare costs associated with tests that do not improve patient care and add to healthcare costs is of the utmost importance. This study was conducted to further characterize, in dollar amounts, the impact of ordering unwarranted imaging. More studies need to be conducted to further characterize clinical practice concerning acute uncomplicated pancreatitis and the utility of computed tomography (CT) imaging.
This study aimed to evaluate how many unwarranted CT scans are performed in patients with acute uncomplicated pancreatitis (AUP) meeting the diagnostic criteria of clinical symptoms and abnormal lab values at our institution. In addition, the study determined if the need of imaging impacted hospital length of stay and how much overall expenditure the hospital spent on the use of unnecessary CT imaging. This study emphasizes the importance of guideline adherence and educating providers on the importance of high value cost conscious care to ultimately improve potential healthcare cost savings and patient care.
A retrospective single center study was performed evaluating the use of CT imaging among patients with acute uncomplicated pancreatitis. Patients were selected from our quaternary referral center, Advocate Christ Medical Center in Oak Lawn, Illinois, USA from January 1, 2012 to October 1, 2017. Patients with acute pancreatitis were included if they had a BISAP and Ranson score of 2 or less, classifying them with uncomplicated pancreatitis. Each patient’s electronic medical record was reviewed to evaluate whether the patient met the clinical and biochemical diagnosis for acute pancreatitis and if they underwent CT imaging. Additional demographic information was collected along with the suspected etiology of a patient’s pancreatitis.
A total of 1305 patients presented to the emergency department with AP; of these, 405 patients (31%) met our inclusion criteria for AUP and were included in the study (201 males, 204 females; mean age 49 years, range 18-98). The utilization of CT imaging was seen in 210 patients (51.85%) that met the clinical and biochemical evidence of AUP upon presentation. One patient (0.47%) had evidence of pancreatic necrosis, one patient had cyst formation (0.47%), and the remaining 208 patients (99.05%) had either normal CT scan imaging or findings consistent with mild AP without necrosis. The use of CT imaging incurred a total cost of $947056, with average cost of $4510. Median length of hospitalization stay did not differ among those that underwent CT imaging compared to those that did not.
Our study showed that CT imaging among patients that meet the diagnostic criteria for acute uncomplicated pancreatitis has significant healthcare costs. In the study time period, almost $1 million was spent on CT imaging that did not improve patient care in regards to hospital length of stay or clinical management. This is especially the case if contrast is used, which can worsen acute pancreatitis. Efforts need to be made to educate providers about acute uncomplicated pancreatitis and the utility of CT imaging in regards to clinical management.
A large multi-centered study should be conducted to confirm our results and investigate whether this CT imaging practice is performed at other hospitals. A future study could involve education to the Emergency Department regarding the utility of CT imaging among patients with acute uncomplicated pancreatitis and evaluating whether this reduced the number of CT imaging studies performed.