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Hospital admission volume does not impact the in-hospital mortality of acute pancreatitis.
HPB (Oxford). 2017 Jan;19(1):21-28
Authors: Kamal A, Sinha A, Hutfless SM, Afghani E, Faghih M, Khashab MA, Lennon AM, Yadav D, Makary MA, Andersen DK, Kalloo AN, Singh VK
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.
PMID: 27887788 [PubMed - indexed for MEDLINE]