Population-based observational study of acute pancreatitis in southern England
File(s)
Published version
Author(s)
PanWessex Study Group, on behalf of the Wessex Surgical Trainee Research Collaborative
Mirnezami, Alex
Knight, Ben
Moran, Brendan
Noble, Fergus
Type
Journal Article
Abstract
Introduction
Acute pancreatitis is a common surgical emergency. Identifying variations in presentation, incidence and management may assist standardisation and optimisation of care. The objective of the study was to document the current incidence management and outcomes of acute pancreatitis against international guidelines, and to assess temporal trends over the past 20 years.
Methods
A prospective four-month audit of patients with acute pancreatitis was performed across the Wessex region. The Atlanta 2012 classifications were used to define cases, severity and complications. Outcomes were recorded using validated systems and correlated against guideline standards. Case ascertainment was validated with clinical coding and hospital episode statistics data.
Results
A total of 283 patient admissions with acute pancreatitis were identified. Aetiology included 153 gallstones (54%), 65 idiopathic (23%), 29 alcohol (10%), 9 endoscopic retrograde cholangiopancreatography (3%), 6 drug related (2%), 5 tumour (2%) and 16 other (6%). Compliance with guidelines had improved compared with our previous regional audit. Results were 6.5% mortality, 74% severity stratification, 23% idiopathic cases, 65% definitive treatment of gallstones within 2 weeks, 39% computed tomography within 6–10 days of severe pancreatitis presentation and 82% severe pancreatitis critical care admission. The Atlanta 2012 severity criteria significantly correlated with critical care stay, length of stay, development of complications and mortality (2% vs 6% vs 36%, P < 0.0001).
Conclusions
The incidence of acute pancreatitis in southern England has risen substantially. The Atlanta 2012 classification identifies patients with severe pancreatitis who have a high risk of fatal outcome. Acute pancreatitis management is seen to have evolved in keeping with new evidence and updated clinical guidelines.
Acute pancreatitis is a common surgical emergency. Identifying variations in presentation, incidence and management may assist standardisation and optimisation of care. The objective of the study was to document the current incidence management and outcomes of acute pancreatitis against international guidelines, and to assess temporal trends over the past 20 years.
Methods
A prospective four-month audit of patients with acute pancreatitis was performed across the Wessex region. The Atlanta 2012 classifications were used to define cases, severity and complications. Outcomes were recorded using validated systems and correlated against guideline standards. Case ascertainment was validated with clinical coding and hospital episode statistics data.
Results
A total of 283 patient admissions with acute pancreatitis were identified. Aetiology included 153 gallstones (54%), 65 idiopathic (23%), 29 alcohol (10%), 9 endoscopic retrograde cholangiopancreatography (3%), 6 drug related (2%), 5 tumour (2%) and 16 other (6%). Compliance with guidelines had improved compared with our previous regional audit. Results were 6.5% mortality, 74% severity stratification, 23% idiopathic cases, 65% definitive treatment of gallstones within 2 weeks, 39% computed tomography within 6–10 days of severe pancreatitis presentation and 82% severe pancreatitis critical care admission. The Atlanta 2012 severity criteria significantly correlated with critical care stay, length of stay, development of complications and mortality (2% vs 6% vs 36%, P < 0.0001).
Conclusions
The incidence of acute pancreatitis in southern England has risen substantially. The Atlanta 2012 classification identifies patients with severe pancreatitis who have a high risk of fatal outcome. Acute pancreatitis management is seen to have evolved in keeping with new evidence and updated clinical guidelines.
Date Issued
2019-09-01
Date Acceptance
2019-02-23
Citation
The Annals of The Royal College of Surgeons of England, 2019, 101 (7), pp.487-494
ISSN
0035-8843
Publisher
Royal College of Surgeons of England
Start Page
487
End Page
494
Journal / Book Title
The Annals of The Royal College of Surgeons of England
Volume
101
Issue
7
Copyright Statement
© 2019 The Royal College of Surgeons of England.
Identifier
https://publishing.rcseng.ac.uk/doi/10.1308/rcsann.2019.0055
Subjects
Science & Technology
Life Sciences & Biomedicine
Surgery
Acute pancreatitis
Audit
Epidemiology
Management
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY
NATIONAL GUIDELINES
SEASONAL-VARIATION
MANAGEMENT
EPIDEMIOLOGY
AUDIT
CHOLECYSTECTOMY
IMPLEMENTATION
STANDARDS
IMPACT
Acute pancreatitis
Audit
Epidemiology
Management
Adult
Age Factors
Aged
Aged, 80 and over
Alcohol Drinking
Cholangiopancreatography, Endoscopic Retrograde
Critical Care
England
Female
Gallstones
Humans
Incidence
Length of Stay
Male
Medical Audit
Middle Aged
Pancreatitis
Patient Admission
Practice Guidelines as Topic
Prospective Studies
Severity of Illness Index
Survival Rate
Treatment Outcome
Young Adult
PanWessex Study Group
Wessex Surgical Trainee Research Collaborative
Humans
Pancreatitis
Gallstones
Cholangiopancreatography, Endoscopic Retrograde
Treatment Outcome
Critical Care
Length of Stay
Patient Admission
Severity of Illness Index
Incidence
Survival Rate
Prospective Studies
Alcohol Drinking
Age Factors
Adult
Aged
Aged, 80 and over
Middle Aged
Medical Audit
England
Female
Male
Practice Guidelines as Topic
Young Adult
Surgery
1103 Clinical Sciences
Publication Status
Published
Date Publish Online
2019-07-30