ORIGINAL ARTICLE
A Population-Based Assessment of the Burden of Acute Pancreatitis in the United States Julia McNabb-Baltar, MD,*Þ Praful Ravi, MD,þ Ghislaine Annie Isabwe, MD,Þ Shadeah Laila Suleiman, BSc,* Mohammad Yaghoobi, MD,Þ§ Quoc-Dien Trinh, MD,||¶ and Peter A. Banks, MD*
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% resulted in admission and 0.7% died. Between 2006 and 2009, the incidence of AP ED visits increased from 9.9 to 10.6 per 10,000 person-years. Patients were more likely to be admitted if sicker (Charlson Comorbidity Index score Q3; OR, 6.48; P G 0.001) and if the etiology of pancreatitis was alcoholic versus biliary (OR, 2.20; P G 0.001). They were more likely to die if sicker (Charlson Comorbidity Index score Q3; OR, 1.51; P G 0.001) and covered with Medicare or Medicaid versus private insurance (OR, 1.40; P G 0.001 and OR, 1.45; P G 0.001, respectively). Conclusions: Emergency department visits for AP represent a significant burden on US health care. Although mortality is lower than previously reported, significant disparities exist in patients presenting with AP with regard to admission and mortality rates. Further investigations are needed to assess these disparities. Key Words: acute pancreatitis, NEDS, mortality (Pancreas 2014;43: 687Y691)
A
mong gastrointestinal disorders, acute pancreatitis (AP) represents 1 of the most common causes for admission from the emergency department (ED), accounting for more than 270,000 hospital admissions in 2009 in the United States.1 It is most commonly caused by biliary obstruction and alcohol abuse, and although patients have a benign course, up to 20% develop severe disease that may be associated with local and systemic complications, including pancreatic walled-off necrosis, compartment syndrome, and development of acute respiratory distress syndrome.2 As such, AP carries a significant mortality rate of between 3% and 5%, although this is showing a downward trend.1,3 Although previous population-based assessments of the burden of AP have been restricted to inpatient cohorts,1,4 the incidence From the *Division of Gastroenterology, Hepatology, and Endoscopy, Center for Pancreatic Disease, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA; †Division of Gastroenterology, McGill University, Montreal, Canada; ‡Center for Outcomes Research and Analytics, Henry Ford Health System, Detroit, MI; §Division of Gastroenterology, University of South Carolina, Charleston, SC; ||Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School; and ¶Harvard School of Public Health, Boston, MA. Received for publication September 6, 2013; accepted January 28, 2014. Reprints: Julia McNabb-Baltar, MD, Center for Pancreatic Disease, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115 (e
A Population-Based Assessment of the Burden of Acute Pancreatitis in the United States Julia McNabb-Baltar, MD,*Þ Praful Ravi, MD,þ Ghislaine Annie Isabwe, MD,Þ Shadeah Laila Suleiman, BSc,* Mohammad Yaghoobi, MD,Þ§ Quoc-Dien Trinh, MD,||¶ and Peter A. Banks, MD*
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% resulted in admission and 0.7% died. Between 2006 and 2009, the incidence of AP ED visits increased from 9.9 to 10.6 per 10,000 person-years. Patients were more likely to be admitted if sicker (Charlson Comorbidity Index score Q3; OR, 6.48; P G 0.001) and if the etiology of pancreatitis was alcoholic versus biliary (OR, 2.20; P G 0.001). They were more likely to die if sicker (Charlson Comorbidity Index score Q3; OR, 1.51; P G 0.001) and covered with Medicare or Medicaid versus private insurance (OR, 1.40; P G 0.001 and OR, 1.45; P G 0.001, respectively). Conclusions: Emergency department visits for AP represent a significant burden on US health care. Although mortality is lower than previously reported, significant disparities exist in patients presenting with AP with regard to admission and mortality rates. Further investigations are needed to assess these disparities. Key Words: acute pancreatitis, NEDS, mortality (Pancreas 2014;43: 687Y691)
A
mong gastrointestinal disorders, acute pancreatitis (AP) represents 1 of the most common causes for admission from the emergency department (ED), accounting for more than 270,000 hospital admissions in 2009 in the United States.1 It is most commonly caused by biliary obstruction and alcohol abuse, and although patients have a benign course, up to 20% develop severe disease that may be associated with local and systemic complications, including pancreatic walled-off necrosis, compartment syndrome, and development of acute respiratory distress syndrome.2 As such, AP carries a significant mortality rate of between 3% and 5%, although this is showing a downward trend.1,3 Although previous population-based assessments of the burden of AP have been restricted to inpatient cohorts,1,4 the incidence From the *Division of Gastroenterology, Hepatology, and Endoscopy, Center for Pancreatic Disease, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA; †Division of Gastroenterology, McGill University, Montreal, Canada; ‡Center for Outcomes Research and Analytics, Henry Ford Health System, Detroit, MI; §Division of Gastroenterology, University of South Carolina, Charleston, SC; ||Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School; and ¶Harvard School of Public Health, Boston, MA. Received for publication September 6, 2013; accepted January 28, 2014. Reprints: Julia McNabb-Baltar, MD, Center for Pancreatic Disease, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115 (e
