Introduction Acute pancreatitis is a common general surgical presentation, requiring input from both surgeons and gastroenterologists. The Newcastle upon Tyne Trust is the regional HPB referral centre for complex pancreatitis for 9 Trusts. The aetiology of acute pancreatitis in the North East is 42.5% gallstone disease,1and the BSG2recommend that cholecystectomy is undertaken in these patients on their index admission. This study describes changes in acute pancreatitis incidence, management and outcomes the last 15 years.
Method Information departments at Newcastle and Gateshead Foundation Trusts were contacted to request data for all emergency admissions under a general surgeon from 2000–2014 after necessary approvals. Acute pancreatitis was identified using the ICD-10 code K85, cholecystectomy using the OPCS code J18, and laparoscopy using code Y50.8, Y75.1 and Y75.2. Data on demographics, co-morbidities, interventions and outcomes were collected and analysed.
Results Acute pancreatitis was common, occurring in 2,334/80,814 cases (2.9%). Mean age was 52.8 years (95% CI: 52.1 to 53.6 years), and 54.3% of patients were men. The overall mean length of stay (LoS) was 11.1 days (95% CI: 10.3 to 11.9 days), and patients who were managed conservatively (1368; 58.6%) had a significantly shorter LoS than those who underwent a procedure (6.0 days vs. 18.3 days, p < 0.001). There were 107 inpatient deaths (4.6%), 78 (72.9%) following an invasive procedure, and 29 (27.1%) with conservative management. There were 161 cholecystectomies (total or partial) performed on index admission (6.9% of total admissions), and the number of cholecystectomies performed and admissions with acute pancreatitis increased from 31/508 (6.1%; 77.4% laparoscopic) in 2000–2004, to 40/859 (4.7%; 82.5% laparoscopic) in 2005–2009, and 90/967 (9.3%; 86.7% laparoscopic) in 2010–2014. The mortality rate from acute pancreatitis fell over the same periods from 6.1% (31), 4.3% (37), to 4.0% (39).
Conclusion The number of procedures performed within this cohort is skewed due to the preponderance of severe cases requiring intervention and are unlikely to represent usual practice in a general hospital. The rates of cholecystectomy on index admission with acute pancreatitis are increasing; however they remain substantially lower than the 42.5% identified by Ellis et al.1We show an increasing incidence of acute pancreatitis, with decreasing mortality, suggesting current management strategies including referral of severe cases to subspecialist multi-disciplinary units is beneficial.
Disclosure of interest None Declared.
Ellis MP, French JJ, Charnley RM. Acute pancreatitis and the influence of socioeconomic deprivation. Br J Surg. 2009;96:74–80. doi: 10.1002/bjs.6414.
BSG. UK Working Party on Acute Pancreatitis. UK guidelines for the management of acute pancreatitis. Gut 2005;54:iii1–iii9.