Mortality following acute pancreatitis: social deprivation, hospital size and time of admission: record linkage study

BMC Gastroenterology

John G Williams³  David G Samuel²  Ashley Akbari³  P Adrian Evans¹  Kymberley Thorne³  Stephen E Roberts³ 

[1] Department of Emergency Medicine, Morriston Hospital, Swansea, UK;Department of Gastroenterology, Prince Philip Hospital, Llanelli, UK;College of Medicine, Swansea University, Singleton Park, Swansea, UK

关键词: Time of admission;    Hospital size;    Social deprivation;    Mortality;    Acute pancreatitis;   

Others  :  1121829
DOI  :  10.1186/1471-230X-14-153

 received in 2013-09-11, accepted in 2014-08-15,  发布年份 2014

【 摘 要 】

Background

Very little is known about whether mortality following acute pancreatitis may be influenced by the following five factors: social deprivation, week day of admission, recruitment of junior doctors in August each year, European Working Time Directives (EWTDs) for junior doctors’ working hours and hospital size. The aim of this study was to establish how mortality following acute pancreatitis may be influenced by these five factors in a large cohort study.

Methods

Systematic record linkage of inpatient, mortality and primary care data for 10 589 cases of acute pancreatitis in Wales, UK (population 3.0 million), from 1999 to 2010. The main study outcome measure was mortality at 60 days following the date of admission.

Results

Mortality was 6.4% at 60 days. There was no significant variation in mortality according to social deprivation or the week day of admission. There was also no significant variation according to calendar month for acute pancreatitis overall or for gallstone aetiology, but for alcoholic acute pancreatitis, mortality was increased significantly by 93% for admissions during the months of August and September and 102% from August to October when compared with all other calendar months. Mortality was increased significantly for alcoholic aetiology in August 2004, the official month that the first EWTD was implemented, but there were no other increases following the first or second EWTDs. There were also indications of increased mortality in large hospitals when compared with small hospitals, for acute pancreatitis overall and for gallstone aetiology but not for alcoholic acute pancreatitis, although these increases in mortality were of quite marginal significance.

Conclusions

Although we found some evidence of increased mortality for patients admitted with alcoholic acute pancreatitis during August to October, in August 2004, and in large hospitals for acute pancreatitis overall and for gallstone aetiology, the study factors had limited impact on mortality following acute pancreatitis and no significant impact when adjusted for multiple comparisons.

【 授权许可】

   
2014 Roberts et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]British Society of Gastroenterology: UK guidelines for the management of acute pancreatitis. Gut 2005, 54(Suppl III):1-9.
• [2]Williams JG, Roberts SE, Ali MF, Cheung WY, Cohen DR, Demery G, Edwards A, Greer M, Hellier MD, Hutchings HA, Ip B, Longo MF, Russell IT, Snooks HA, Williams JC: Gastroenterology services in the UK. The burden of disease, and the organisation and delivery of services for gastrointestinal and liver disorders: a review of the evidence. Gut 2007, 56(Suppl 1):1-113.
• [3]Roberts SE, Williams JG, Meddings D, Goldacre MJ: Incidence and case fatality for acute pancreatitis in England: geographical variation, social deprivation, alcohol consumption and aetiology–a record linkage study. Aliment Pharmacol Ther 2008, 28:931-941.
• [4]Floyd A, Pedersen L, Nielsen GL, Thorladcius-Ussing O, Sorensen HT: Secular trends in incidence and 30-day case fatality of acute pancreatitis in North Jutland County, Denmark: a register-based study from 1981–2000. Scand J Gastroenterol 2002, 37:1461-1465.
• [5]Tinto A, Lloyd DA, Kang JY, Majeed A, Ellis C, Williamson RC: Acute and chronic pancreatitis-diseases on the rise: a study of hospital admissions in England 1989/90-1999/2000. Aliment Pharmacol Ther 2002, 16:2097-2105.
• [6]Goldacre MJ, Roberts SE: Hospital admission for acute pancreatitis in an English population, 1963–98: database study of incidence and mortality. BMJ 2004, 328:1466-1469.
• [7]Frey CF, Zhou H, Harvey DJ, White RH: The incidence and case-fatality rates of acute biliary, alcoholic, and idiopathic pancreatitis in California, 1994–2001. Pancreas 2006, 33:336-344.
• [8]Sandzen B, Rosenmuller M, Haapamaki MM, Nilsson E, Stenlund HC, Oman M: First attack of acute pancreatitis in Sweden 1988–2003: incidence, aetiological classification, procedures and mortality - a register study. BMC Gastroenterol 2009, 9:18. BioMed Central Full Text
• [9]Apelros S, Borgstrom A: Incidence, aetiology and mortality rate of acute pancreatitis over 10 years in a defined urban population in Sweden. Br J Surg 1999, 86:465-470.
• [10]Jarman B, Gault S, Alves B, Hider A, Dolan S, Cook A, Hurwitz B, Iezzoni LI: Explaining differences in English hospital death rates using routinely collected data. BMJ 1999, 318:1515-1520.
• [11]Collum J, Harrop J, Stokes M, Kendall D: Patient safety and quality of care continue to improve in NHS North West following early implementation of the European Working Time Directive. QJM 2010, 103:929-940.
• [12]McIntyre HF, Winfield S, Te HS, Crook D: Implementation of the European Working Time Directive in an NHS trust: impact on patient care and junior doctor welfare. Clin Med 2010, 10:134-137.
• [13]Jen MH, Bottle A, Majeed A, Bell D, Aylin P: Early in-hospital mortality following trainee doctors’ first day at work. PLoS ONE 2009, 4:e7103.
• [14]Kostis WJ, Demissie K, Marcella SW, Shao YH, Wilson AC, Moreyra AE: Weekend versus weekday admission and mortality from myocardial infarction. N Engl J Med 2007, 356:1099-1109.
• [15]Saposnik G, Baibergenova A, Bayer N, Hachinski V: Weekends: a dangerous time for having a stroke? Stroke 2007, 38:1211-1215.
• [16]Palmer WL, Bottle A, Davie C, Vincent CA, Aylin P: Dying for the weekend: a retrospective cohort study on the association between day of hospital presentation and the quality and safety of stroke care. Arch Neurol 2012, 69:1296-1302.
• [17]Handel AE, Patel SV, Skingsley A, Bramley K, Sobieski R, Ramagopalan SV: Weekend admissions as an independent predictor of mortality: an analysis of Scottish hospital admissions. BMJ Open 2012, 2:e001789.
• [18]Andrén-Sandberg A: Organization of care for pancreatic cancer. N Am J Med Sci 2011, 3:400-405.
• [19]Singla A, Csikesz NG, Simons JP, Li YF, Ng SC, Tseng JF, Shah SA: National hospital volume in acute pancreatitis: analysis of the Nationwide Inpatient Sample 1998–2006. HPB (Oxford) 2009, 11:391-397.
• [20]Murata A, Matsuda S, Mayumi T, Yokoe M, Kuwabara K, Ichimiya Y, Fujino Y, Kubo T, Fujimori K, Horiguchi H: Effect of hospital volume on clinical outcome in patients with acute pancreatitis, based on a national administrative database. Pancreas 2011, 40:1018-1023.
• [21]Shen HN, Lu CL, Li CY: The effect of hospital volume on patient outcomes in severe acute pancreatitis. BMC Gastroenterol 2012, 12:112. BioMed Central Full Text
• [22]Roberts SE, Akbari A, Thorne K, Atkinson M, Evans PA: The incidence of acute pancreatitis: impact of social deprivation, alcohol consumption, seasonal and demographic factors. Aliment Pharmacol Ther 2013, 38:539-548.
• [23]Ford DV, Jones KH, Verplancke JP, Lyons RA, John G, Brown G, Brooks CJ, Thompson S, Bodger O, Couch T, Leake K: The SAIL Databank: building a national architecture for e-health research and evaluation. BMC Health Serv Res 2009, 9:157. BioMed Central Full Text
• [24]Lyons RA, Jones KH, John G, Brooks CJ, Verplancke JP, Ford DV, Brown G, Leake K: The SAIL databank: linking multiple health and social care datasets. BMC Med Inform Decis Mak 2009, 9:3. BioMed Central Full Text
• [25]Paranjothy S, Fone D, Mann M, Dunstan F, Evans E, Tomkinson A, Sibert J, Kemp A: The incidence and aetiology of epistaxis in infants: a population-based study. Arch Dis Child 2009, 94:421-424.
• [26]Roberts SE, Button LA, Williams JG: Prognosis following upper gastrointestinal bleeding. PLoS ONE 2012, 7:e49507.
• [27]Button LA, Roberts SE, Evans PA, Goldacre MJ, Akbari A, Dsilva R, Macey S, Williams JG: Hospitalized incidence and case fatality for upper gastrointestinal bleeding from 1999 to 2007: a record linkage study. Aliment Pharmacol Ther 2011, 33:64-76.
• [28]Roberts SE, Button LA, Hopkin JM, Goldacre MJ, Lyons RA, Rodgers SE, Akbari A, Lewis KE: Influence of social deprivation and air pollutants on serious asthma. Eur Respir J 2012, 40:785-788.
• [29]Button LA, Roberts SE, Goldacre MJ, Akbari A, Rodgers SE, Williams JG: Hospitalised prevalence and 5 year mortality for IBD: Record linkage study. World J Gastroenterol 2010, 16:431-438.
• [30]Fone DL, Dunstan F, White J, Kelly M, Farewell D, John G, Lyons RA, Lloyd K: Cohort profile: the Caerphilly health and social needs electronic cohort study (E-CATALyST). Int J Epidemiol 2013, 42:1620-1628.
• [31]Welsh Assembly Government: Welsh Index of Multiple Deprivation 2005. Cardiff: Welsh Assembly Government; 2005.
• [32]Communities and Local Government: The English Indices of Deprivation 2010. London: Communities and Local Government; 2011.
• [33]Roberts SE, Williams JG, Cohen DR, Akbari A, Groves S, Button LA: Feasibility of using routinely collected inpatient data to monitor quality and inform choice: a case study using the UK Inflammatory Bowel Disease audit. Frontline Gastroenterol 2011, 2:153-159.
• [34]Chowdhury MM, Dagash H, Pierro A: A systematic review of the impact of volume of surgery and specialization on patient outcome. Br J Surg 2007, 94:145-161.
• [35]McAteer JP, Lariviere CA, Drugas GT, Abdullah F, Oldham KT, Goldin AB: Influence of surgeon experience, hospital volume, and specialty designation on outcomes in pediatric surgery: a systematic review. JAMA Pediatr 2013, 167:468-475.
• [36]Gallerani M, Imberti D, Bossone E, Eagle KA, Manfredini R: Higher mortality in patients hospitalized for acute aortic rupture or dissection during weekends. J Vasc Surg 2012, 55:1247-1254.
• [37]Shaheen AA, Kaplan GG, Myers RP: Weekend versus weekday admission and mortality from gastrointestinal hemorrhage caused by peptic ulcer disease. Clin Gastroenterol Hepatol 2009, 7:303-310.
• [38]Smith S, Allan A, Greenlaw N, Finlay S, Isles C: Emergency medical admissions, deaths at weekends and the public holiday effect. Cohort study. Emerg Med J 2014, 31:30-34.
• [39]Zucker SD: Cirrhosis-associated mortality: frankly, Scarlet, do we really make a damn? Gastroenterology 2006, 131:320-322.
• [40]Kim HS, Park CW, Yoo CJ, Kim EY, Kim YB, Kim WK: Impact of admission month on outcomes in spontaneous subarachnoid hemorrhage: evidence against the march effect. J Cerebrovasc Endovasc Neurosurg 2013, 15:67-75.
• [41]McDonald JS, Clarke MJ, Helm GA, Kallmes DF: The effect of July admission on inpatient outcomes following spinal surgery. J Neurosurg Spine 2013, 18:280-288.
• [42]Anderson KL, Koval KJ, Spratt KF: Hip fracture outcome: is there a “July effect”? Am J Orthop (Belle Mead NJ) 2009, 38:606-611.
• [43]Maxwell AJ, Crocker M, Jones TL, Bhagawati D, Papadopoulos MC, Bell BA: Implementation of the European Working Time Directive in neurosurgery reduces continuity of care and training opportunities. Acta Neurochir (Wien) 2010, 152:1207-1210.
• [44]Goddard AF, Hodgson H, Newbery N: Impact of EWTD on patient:doctor ratios and working practices for junior doctors in England and Wales 2009. Clin Med 2010, 10:330-335.