Outcomes of pancreatic debridement in acute pancreatitis: analysis of the nationwide inpatient sample from 1998 to 2010

• Published in: The American journal of surgery 2014-09, Vol.208 (3), p.350-362
• Main Authors: Wormer, Blair A., M.D, Swan, Ryan Z., M.D, Williams, Kristopher B., M.D, Bradley, Joel F., M.D, Walters, Amanda L., M.S, Augenstein, Vedra A., M.D, Martinie, John B., M.D, Heniford, B. Todd, M.D., F.A.C.S
• Format: Article
• Language: English
• Subjects: Acute Disease; Acute pancreatitis; Adolescent; Adult; Aged; Aged, 80 and over; Classification; Codes; Confidence intervals; Debridement; Disease; Female; Health maintenance organizations; HIV; HMOs; Hospital Mortality - trends; Hospitals; Human immunodeficiency virus; Humans; Incidence; Infections; Logistic Models; Male; Middle Aged; Mortality; Nationwide inpatient sample; Necrosectomy; Necrotizing pancreatitis; Pancreas; Pancreatic debridement; Pancreatitis - epidemiology; Pancreatitis - mortality; Pancreatitis - surgery; Patients; Respiratory distress syndrome; Rheumatic diseases; Risk Factors; Surgery; Surgical outcomes; Treatment Outcome; Tumors; United States - epidemiology; Young Adult
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2013.12.030

Abstract Background The objective of this study was to perform a national review of patients with acute pancreatitis (AP) who undergo pancreatic debridement (PD) to evaluate for risk factors of in-hospital mortality. Methods The Nationwide Inpatient Sample was used to identify patients with AP who underwent PD between 1998 and 2010. Risk factors for in-hospital mortality were assessed with multivariate logistic regression. Results From 1998 to 2010, there were 585,978 nonelective admissions with AP, of which 1,783 (.3%) underwent PD. From 1998 to 2010, the incidence of PD decreased from .44% to .25% ( P < .01) and PD in-hospital mortality decreased from 29.0% to 15% ( P < .05). Of patients undergoing PD, independent factors associated with increased odds of mortality were increased age (odds ratio [OR] 1.04, confidence interval [CI] 1.03 to 1.05; P < .01), sepsis with organ failure (OR 1.76, CI 1.24 to 2.51; P < .01), peptic ulcer disease (OR 1.83, CI 1.02 to 3.30; P < .05), liver disease (OR 2.27, CI 1.36 to 3.78; P  < .01), and renal insufficiency (OR 1.78, CI 1.14 to 2.78; P < .05). Conclusions The incidence and operative mortality of PD have decreased significantly over the last decade in the United States with higher odds of dying in patients who are older, with chronic liver, renal, or ulcer disease, and higher rates of sepsis with organ failure.