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

Published on Jan 1, 2017in Hpb3.401
· DOI :10.1016/J.HPB.2016.10.013
Ayesha Kamal10
Estimated H-index: 10
(JHUSOM: Johns Hopkins University School of Medicine),
Amitasha Sinha9
Estimated H-index: 9
(JHUSOM: Johns Hopkins University School of Medicine)
+ 9 AuthorsVikesh K. Singh48
Estimated H-index: 48
(JHUSOM: Johns Hopkins University School of Medicine)
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.
📖 Papers frequently viewed together
1 Citations
#1Julia McNabb-BaltarH-Index: 10
#2Praful RaviH-Index: 21
Last. Peter A. BanksH-Index: 74
view all 7 authors...
OBJECTIVES: The aim of this study is to investigate the incidence and mortality of emergency department (ED) visits in the United States attributed to acute pancreatitis (AP) and quantify predictors of admission and mortality. METHODS: Using the nationwide ED sample, all ED visits between 2006 and 2009 for AP were extracted. Multivariable analyses were fitted for prediction of admission and mortality. RESULTS: A weighted sample of 1,224,121 patient visits with AP was captured. Of those, 75.4% re...
40 CitationsSource
#1Qiang Guo (Sichuan University)H-Index: 9
#2Ang LiH-Index: 1
Last. Wei-ming HuH-Index: 1
view all 15 authors...
OBJECTIVE: To clarify the roles of organ failure and infection in the outcome of necrotizing pancreatitis. BACKGROUND: Results of previous cohort studies that focused on the roles of infection and organ failure in acute pancreatitis are controversial. METHODS: In this study, we collected the medical records of 447 patients with necrotizing pancreatitis from January 2009 to June 2012. Data associated with organ failure and infection were analyzed. RESULTS: The overall mortality rate was 13% (58/4...
78 CitationsSource
#1Graeme J Duke (Box Hill Hospital)H-Index: 3
#2Anna BarkerH-Index: 20
Last. John D. Santamaria (St. Vincent's Health System)H-Index: 25
view all 5 authors...
There are useful insights to be gained from long-range retrospective analysis of intensive care outcomes at state and national level. Such an overview may provide unique insights into resources and outcomes and help in future planning. One way to assess this is to interrogate large datasets collected over many years. This type of analysis has previously been undertaken in a select population of intensive care unit patients in Australia and New Zealand (in 1993–2003), 1 and more recently in the U...
3 Citations
#1Tsuyoshi Hamada (UTokyo: University of Tokyo)H-Index: 38
#2Hideo Yasunaga (UTokyo: University of Tokyo)H-Index: 55
Last. Kazuhiko Koike (UTokyo: University of Tokyo)H-Index: 91
view all 7 authors...
Background Although several population-based studies have shown higher hospital volume (HV) to be associated with better outcomes in acute pancreatitis, they failed to adjust for disease severity and did not take into account the potentially non-linear relationship between HV and outcomes. Using a Japanese nationwide administrative database, this study aimed to evaluate the volume–outcome relationship in acute pancreatitis by means of statistical methods that permitted such considerations.
16 CitationsSource
#1Soumitra S. Bhuyan (Nebraska Medical Center)H-Index: 11
#2Yang Wang (Nebraska Medical Center)H-Index: 9
Last. Ge Lin (Nebraska Medical Center)H-Index: 2
view all 4 authors...
Aims: Acute myocardial infarction (AMI) remains a major cause of death and disability in the United States and worldwide. Despite the importance of surveillance and secondary prevention, the incidence of and mortality from AMI are not continuously monitored, and little is known about survival outcomes after 30 days of AMI hospitalization or associated risk factors, especially in the rural areas. The current study examines ruraleurban differences in both in- and out-hospital survival outcomes for...
20 CitationsSource
#1Timothy Shiraev (ND: University of Notre Dame)H-Index: 5
#2Michael G. Condous (St John of God Health Care)H-Index: 1
Background Rural and regional populations suffer higher rates of preventable disease and all-cause mortality than urban areas, with rural areas of the USA experiencing double the rate of ruptured abdominal aortic aneurysms (AAAs). We investigated the incidence and outcomes of ruptured AAAs in an Australian rural and regional setting, and compared these with those of an urban population. Methods We undertook a retrospective analysis of all patients suffering AAA rupture in New South Wales (NSW) f...
8 CitationsSource
#1Chisa Matsumoto (Brigham and Women's Hospital)H-Index: 21
#2Nirupa R. MatthanH-Index: 35
Last. Luc DjousséH-Index: 79
view all 5 authors...
Background: Previous studies have reported beneficial effects of a Mediterranean diet rich in monounsaturated fatty acids (MUFAs) on coronary artery disease (CAD) risk. However, these findings remain inconsistent because some experimental studies have suggested atherogenic and lipotoxicity effects of long-chain and very-long-chain MUFAs on cardiomyocytes. Objective: We examined whether red blood cell (RBC) long-chain and very-long-chain MUFAs are associated with risk of CAD in the Physicians’ He...
18 CitationsSource
#2Thakur Deen YadavH-Index: 14
Last. Rakesh KochharH-Index: 33
view all 6 authors...
Background and aims In acute pancreatitis (AP), patients with persistent organ failure [POF, duration of organ failure (OF) ≥48 h] and transient organ failure (TOF, duration of OF <48 h) have different outcomes. We have compared the clinical course and outcome of patients with severe AP (SAP) with TOF and POF in the first week of hospitalization as well as the impact of change in the OF score in the first week on patient outcome.
33 CitationsSource
#1Jie-Yao Li (SYSU: Sun Yat-sen University)H-Index: 11
#2Tao Yu (SYSU: Sun Yat-sen University)H-Index: 15
Last. Qi-Kui Chen (SYSU: Sun Yat-sen University)H-Index: 18
view all 7 authors...
Background Enteral nutrition is increasingly advocated in the treatment of acute pancreatitis, but its timing is still controversial. The aim of this meta-analysis was to find out the feasibility of early enteral nutrition within 48 hours of admission and its possible advantages. Methods and Findings We searched PubMed, EMBASE Databases, Web of Science, the Cochrane library, and for all the relevant articles about the effect of enteral nutrition initiated within 48 hours of ad...
73 CitationsSource
#1Peter A. Banks (Brigham and Women's Hospital)H-Index: 74
#2Thomas L. BollenH-Index: 44
Last. Santhi Swaroop Vege (Mayo Clinic)H-Index: 50
view all 8 authors...
Background and objective The Atlanta classification of acute pancreatitis enabled standardised reporting of research and aided communication between clinicians. Deficiencies identified and improved understanding of the disease make a revision necessary. Methods A web-based consultation was undertaken in 2007 to ensure wide participation of pancreatologists. After an initial meeting, the Working Group sent a draft document to 11 national and international pancreatic associations. This working dra...
2,841 CitationsSource
Cited By6
#1Igor Kryvoruchko (Kharkiv National Medical University)
#2Anastasiya Drozdova (Kharkiv National Medical University)
Last. Nataliya Goncharova (Kharkiv National Medical University)
view all 3 authors...
The review presents a modern view on the features of the course and treatment of acute pancreatitis, based on a cascade of pathophysiological mechanisms of this disease. A number of concepts of development and course of acute pancreatitis on the basis of randomized prospective and retrospective researches devoted to this problem are considered. Attention is paid to the mechanisms of development of organ failure in acute pancreatitis. In accordance with the above, the main positions of treatment ...
#1Jorge D. Machicado (Mayo Clinic)H-Index: 13
#2Amir Gougol (University of Pittsburgh)H-Index: 6
Last. Georgios I. Papachristou (University of Pittsburgh)H-Index: 49
view all 31 authors...
BACKGROUND Persistent organ failure (POF) is the strongest determinant of mortality in acute pancreatitis (AP). There is a paucity of data regarding the impact of different POF attributes on mortality and the role of different characteristics of systemic inflammatory response syndrome (SIRS) in the risk of developing POF. OBJECTIVE We aimed to assess the association of POF dynamic features with mortality and SIRS characteristics with POF. METHODS We studied 1544 AP subjects prospectively enrolle...
#1Bryan D. Badal (The Ohio State University Wexner Medical Center)
#2Andrew J. Kruger (The Ohio State University Wexner Medical Center)H-Index: 4
Last. Somashekar G. Krishna (The Ohio State University Wexner Medical Center)H-Index: 21
view all 10 authors...
Abstract Background There is limited research in prognosticators of hospital transfer in acute pancreatitis (AP). Hence, we sought to determine the predictors of hospital transfer from small/medium-sized hospitals and outcomes following transfer to large acute-care hospitals. Methods Using the 2010–2013 Nationwide Inpatient Sample (NIS), patients ≥18 years of age with a primary diagnosis of AP were identified. Hospital size was classified using standard NIS Definitions. Multivariable analyses we...
Last. M. SaiaH-Index: 1
view all 7 authors...
OBJECTIVES: This study aimed to evaluate trends in hospitalizations and outcomes of acute pancreatitis (AP) according to first admitting hospital unit and hospital volumes. METHODS: Hospital discharge records of patients with AP admitted in the Veneto Region (Northeast Italy) during the period 2001-2015 were examined. RESULTS: A total of 23,389 patients (54% males; mean age, 62.2 years; standard deviation, 19.3 years) were admitted for AP. Both hospitalization (32.4 to 29.5/100,000 inhabitants p...
#1Pramod Kumar Garg (AIIMS: All India Institute of Medical Sciences)H-Index: 48
#2Vijay Singh (Mayo Clinic)H-Index: 66
Acute pancreatitis may be associated with both local and systemic complications. Systemic injury manifests in the form of organ failure, which is seen in approximately 20% of all cases of acute pancreatitis and defines "severe acute pancreatitis." Organ failure typically develops early in the course of acute pancreatitis, but also may develop later due to infected pancreatic necrosis–induced sepsis. Organ failure is the most important determinant of outcome in acute pancreatitis. We review here ...
63 CitationsSource
#1David D. Keeven (UK: University of Kentucky)H-Index: 2
#2Charles T. Harris (UK: University of Kentucky)H-Index: 1
Last. Andrew C. Bernard (UK: University of Kentucky)H-Index: 21
view all 5 authors...
Abstract Background Recent articles have suggested regionalization of some emergency general surgery (EGS) problems to tertiary referral centers. We sought to characterize the clinical and cost burden of such transfers to our tertiary referral center. Materials and methods Data were collected retrospectively for nine EGS diagnoses for patients admitted to the EGS service during calendar years 2015 and 2016. Patients were grouped as inpatient transfers (IPTs), Emergency Department transfers (EDTs...
3 CitationsSource