Inpatient Alcohol Cessation Counseling Is Associated With a Lower 30-Day Hospital Readmission in Alcoholic Pancreatitis

Introduction: Excessive alcohol use is a common cause of acute pancreatitis (AP) and recurrent episodes of AP are associated with ongoing alcohol abuse. Thus, guidelines recommend intervention by providing alcohol relapse prevention resources during admission. There is limited data on the real-world implementation of this recommendation. Thus we aimed to assess how often inpatients admitted with alcohol-induced AP (AAP) receive counselling and to determine the impact of this intervention on readmissions. Methods: We conducted a retrospective cohort study of all adult patients admitted with AAP at a tertiary care center from 2008-2018. AP was defined by the revised Atlanta criteria. We compared demographics, clinical features, severity of pancreatitis and outcomes data in patients who did and did not receive counseling. Primary outcome was the proportion of patients with AAP receiving counselling. Secondary outcomes included readmission rate for AAP at 30 days and 1 year. Multivariate regression analysis and t-test were used for analysis. Results: A total of 243 patients with AAP were identified of which 115 had alcohol counseling (47%). The two groups were similar in age, sex, ethnicity, alcohol and tobacco use, severity of pancreatitis, and previous episodes of AAP. Patients who did not receive counselling had a shorter length of stay (3.0 vs 4.61 days, p< 0.01) and a higher proportion were discharged on opioids (55.9% vs 33% p< 0.01). The frequency of inpatient alcohol withdrawal was similar in both groups. A significantly smaller proportion of patients receiving alcohol counselling were readmitted at 30 days compared to patients not receiving counselling (19.3% versus 31.2%, P=0.048). At 1 year, the two groups had similar readmission rates. In a multivariate analysis, patients who received counselling were two times less likely to be readmitted in 30 days than those who did not receive counselling, (OR 0.52[0.27, 0.98], P=0.046) after adjusting for age, race, current tobacco use, and prior history of AP. Conclusion: We note that less than 50% of patients receive alcohol counselling. Importantly patients receiving alcohol counselling were less likely to be readmitted at 30 days inferring possible value in the intervention provided. Similar readmission rates at 1 year suggest that the single intervention may not have a durable effect on alcohol prevention. Further work is needed to provide alcohol prevention resources to patients admitted with AAP.Table 1.: Clinical characteristics and outcomes in patients with and without alcohol counseling.