Nicholas E Ingraham1, Samantha King2, Jennifer Proper3, Lianne Siegel3, Emily J Zolfaghari2, Thomas A Murray3, Victor Vakayil4, Adam Sheka4, Ruoying Feng5, Gabriel Guzman5, Samit Sunny Roy2, Dhannanjay Muddappa3, Michael G Usher5, Jeffrey G Chipman4, Christopher J Tignanelli4,6,7, Kathryn M Pendleton1. 1. Department of Medicine, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota, Minneapolis, Minnesota, USA. 2. University of Minnesota Medical School, Minneapolis, Minnesota, USA. 3. Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA. 4. Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA. 5. Department of Medicine, Division of General Internal Medicine, University of Minnesota, Minneapolis, Minnesota, USA. 6. Department of Surgery, North Memorial Health Hospital, Robbinsdale, Minnesota, USA. 7. Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota, USA.
Abstract
Background: Pancreatitis accounts for more than $2.5 billion of healthcare costs and remains the most common gastrointestinal (GI) admission. Few contemporary studies have assessed temporal trends of incidence, complications, management, and outcomes for acute pancreatitis in hospitalized patients at the national level. Methods: We used data from one of the largest hospital-based databases available in the United States, the Healthcare Cost and Utilization Project's (HCUP) State Inpatient Database, from 10 states between 2008 and 2015. We included patients with a diagnosis of acute pancreatitis (ICD-9 CM 577.0). Patient- and hospital-level data were used to estimate incidence and inpatient mortality rates. Results: From 80,736,256 hospitalizations, 929,914 (1.15%) cases of acute pancreatitis were identified, 186,226 (20.2%) of which were caused by gallbladder disease). The median age was 53 years (interquartile range [IQR], 41-67) and 50.8% were men. In-hospital mortality was 2.5% and crude mortality rates declined from 2.9% to 2.0% over the study period. Admission year remained significant after adjusting for patient demographics and comorbidities (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.89-0.90; p < 0.001). Gallbladder disease was associated with decreased odds of mortality (OR, 0.60; 95% CI, 0.57-0.62). Median length of stay was four days (IQR, 2-7) and decreased over time. The rates of surgical and endoscopic interventions were highest in 2011 (peak incidence of 16.1% and 9.5%, respectively) and have been decreasing since. Surgical providers were, on average, more likely than medical providers to perform surgery in both those with and without gallbladder disease etiology (gallbladder disease OR, 7.11; 95% CI, 5.46-9.25; non-gallbladder disease OR, 20.50; 95% CI, 16.81-25.01), endoscopy (gallbladder disease OR, 1.22; 95% CI, 0.87-1.72; non-gallbladder disease OR, 1.60; 95% CI, 1.18-2.16), or both (gallbladder disease OR, 7.00; 95% CI, 5.22-9.37; non-gallbladder disease OR, 8.85; 95% CI, 5.61-13.96). Conclusions: The incidence of pancreatitis, from 2008 to 2015, has increased whereas inpatient mortality (i.e., case fatality) has decreased. Understanding temporal trends in outcomes and management along with provider, hospital, and regional variation can better identify areas for future research and collaboration in managing these patients.
Background: Pancreatitis accounts for more than $2.5 billion of healthcare costs and remains the most common gastrointestinal (GI) admission. Few contemporary studies have assessed temporal trends of incidence, complications, management, and outcomes for acute pancreatitis in hospitalized patients at the national level. Methods: We used data from one of the largest hospital-based databases available in the United States, the Healthcare Cost and Utilization Project's (HCUP) State Inpatient Database, from 10 states between 2008 and 2015. We included patients with a diagnosis of acute pancreatitis (ICD-9 CM 577.0). Patient- and hospital-level data were used to estimate incidence and inpatient mortality rates. Results: From 80,736,256 hospitalizations, 929,914 (1.15%) cases of acute pancreatitis were identified, 186,226 (20.2%) of which were caused by gallbladder disease). The median age was 53 years (interquartile range [IQR], 41-67) and 50.8% were men. In-hospital mortality was 2.5% and crude mortality rates declined from 2.9% to 2.0% over the study period. Admission year remained significant after adjusting for patient demographics and comorbidities (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.89-0.90; p < 0.001). Gallbladder disease was associated with decreased odds of mortality (OR, 0.60; 95% CI, 0.57-0.62). Median length of stay was four days (IQR, 2-7) and decreased over time. The rates of surgical and endoscopic interventions were highest in 2011 (peak incidence of 16.1% and 9.5%, respectively) and have been decreasing since. Surgical providers were, on average, more likely than medical providers to perform surgery in both those with and without gallbladder disease etiology (gallbladder disease OR, 7.11; 95% CI, 5.46-9.25; non-gallbladder disease OR, 20.50; 95% CI, 16.81-25.01), endoscopy (gallbladder disease OR, 1.22; 95% CI, 0.87-1.72; non-gallbladder disease OR, 1.60; 95% CI, 1.18-2.16), or both (gallbladder disease OR, 7.00; 95% CI, 5.22-9.37; non-gallbladder disease OR, 8.85; 95% CI, 5.61-13.96). Conclusions: The incidence of pancreatitis, from 2008 to 2015, has increased whereas inpatient mortality (i.e., case fatality) has decreased. Understanding temporal trends in outcomes and management along with provider, hospital, and regional variation can better identify areas for future research and collaboration in managing these patients.
Authors: Susan R Kahn; David R Morrison; Jacqueline M Cohen; Jessica Emed; Vicky Tagalakis; Andre Roussin; William Geerts Journal: Cochrane Database Syst Rev Date: 2013-07-16
Authors: Nicholas E Ingraham; Victor Vakayil; Kathryn M Pendleton; Alexandria J Robbins; Rebecca L Freese; Elise F Northrop; Melissa E Brunsvold; Anthony Charles; Jeffrey G Chipman; Christopher J Tignanelli Journal: Crit Care Med Date: 2020-11 Impact factor: 9.296
Authors: Ahmed Dirweesh; Yiting Li; Guru Trikudanathan; J Shawn Mallery; Martin L Freeman; Stuart K Amateau Journal: Gastroenterology Date: 2020-07-25 Impact factor: 22.682
Authors: Joshua A Greenberg; Jonathan Hsu; Mohammad Bawazeer; John Marshall; Jan O Friedrich; Avery Nathens; Natalie Coburn; Gary R May; Emily Pearsall; Robin S McLeod Journal: Can J Surg Date: 2016-04 Impact factor: 2.089