Hospital admission volume does not impact the in-hospital mortality of acute pancreatitis

Ayesha Kamal; Amitasha Sinha; Susan M Hutfless; Elham Afghani; Mahya Faghih; Mouen A Khashab; Anne Marie Lennon; Dhiraj Yadav; Martin A Makary; Dana K Andersen; Anthony N Kalloo; Vikesh K Singh

doi:10.1016/j.hpb.2016.10.013

Hospital admission volume does not impact the in-hospital mortality of acute pancreatitis

HPB (Oxford). 2017 Jan;19(1):21-28. doi: 10.1016/j.hpb.2016.10.013. Epub 2016 Nov 23.

Authors

Affiliations

¹ Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
² Center for Digestive Diseases, Cedars-Sinai Medical Center in Los Angeles, CA, USA.
³ Division of Gastroenterology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
⁴ Pancreatitis Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Surgical Oncology, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁵ National Institutes of Digestive and Kidney Disease, National Institutes of Health, Bethesda, MD, USA.
⁶ Pancreatitis Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁷ Pancreatitis Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: [email protected].

PMID: 27887788
DOI: 10.1016/j.hpb.2016.10.013

Abstract

Background: Multiple factors influence mortality in Acute Pancreatitis (AP).

Methods: To evaluate the association of demographic, clinical, and hospital factors with the in-hospital mortality of AP using a population-based administrative database. The Maryland HSCRC database was queried for adult (≥18 years) admissions with primary diagnosis of AP between 1/94-12/10. Organ failure (OF), interventions, hospital characteristics and referral status were evaluated.

Results: There were 72,601 AP admissions across 48 hospitals in Maryland with 885 (1.2%) deaths. A total of 1657 (2.3%) were transfer patients, of whom 101 (6.1%) died. Multisystem OF was present in 1078 (1.5%), of whom 306 (28.4%) died. On univariable analysis, age, male gender, transfer status, comorbidity, OF, all interventions, and all hospital characteristics were significantly associated with mortality; however, only age, transfer status, OF, interventions, and large hospital size were significant in the adjusted analysis. Patients with commercial health insurance had significantly less mortality than those with other forms of insurance (OR 0.65, 95% CI: 0.52, 0.82, p = 0.0002).

Conclusion: OF is the strongest predictor of mortality in AP after adjusting for demographic, clinical, and hospital characteristics. Admission to HV or teaching hospital has no survival benefit in AP after adjusting for OF and transfer status.

MeSH terms

Acute Disease
Age Factors
Databases, Factual
Female
Health Facility Size / trends*
Hospital Mortality / trends*
Humans
Male
Maryland
Multiple Organ Failure / mortality
Pancreatitis / diagnosis
Pancreatitis / mortality*
Pancreatitis / therapy
Patient Admission / trends*
Patient Transfer / trends
Process Assessment, Health Care / trends*
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome