Abstract
Early definitive treatment (cholecystectomy or endoscopic sphincterotomy in the same admission or within 2 weeks after discharge) of gallstone disease after a biliary attack of acute pancreatitis is standard of care. This study investigated whether compliance with early definitive treatment for acute gallstone pancreatitis can be used as a care quality indicator for the condition. A retrospective cohort study was conducted using the Hospital Episode Statistics database. All emergency admissions to National Health Service hospitals in England with a first time diagnosis of acute gallstone pancreatitis in the financial years 2008, 2009 and 2010 were examined. Trends in early definitive treatment between hospital trusts were examined and patient morbidity outcomes were determined. During the study interval there were 19 510 patients with an overall rate of early definitive treatment at 34·7 (range 9·4-84·7) per cent. In the 1-year follow-up period, 4661 patients (23·9 per cent) had one or more emergency readmissions for complications related to gallstone pancreatitis. Of these, 2692 (57·8 per cent) were readmissions for acute pancreatitis; 911 (33·8 per cent) were within the first 2 weeks of discharge, with the remaining 1781 (66·2 per cent) occurring after the point at which definitive treatment should have been received. Early definitive treatment resulted in a 39 per cent reduction in readmission risk (adjusted risk ratio (RR) 0·61, 95 per cent c.i. 0·58 to 0·65). The risk was further reduced for acute pancreatitis readmissions to 54 per cent in the early definitive treatment group (adjusted RR 0·46, 0·42 to 0·51). In acute gallstone pancreatitis, compliance with recommended early definitive treatment varied considerably, with associated variation in outcomes. Compliance should be used as a quality indicator to improve care.
Highlights
Acute pancreatitis is one of the most common intra-abdominal emergency conditions and is rising in incidence, with a year on year rise in English hospital admissions from 11,949 in 2000 to 20,682 in 2012 [3]
It still causes significant morbidity and mortality [6,7]. In recognition of this in 2005 the UK British Society of Gastroenterology (BSG) Working Party on Acute Pancreatitis released a revised version of their 1998 guidelines for best practice management of acute gallstone pancreatitis (GSP) 8. This advised that patients with mild GSP should undergo definitive treatment of their gallstones (either cholecystectomy or Endoscopic Sphincterotomy) during the same hospital admission or within two weeks of discharge
The study indicates that the rate of early definitive treatment for gallstones following an attack of acute GSP is a potentially valid quality of care measure
Summary
Acute pancreatitis is one of the most common intra-abdominal emergency conditions and is rising in incidence, with a year on year rise in English hospital admissions from 11,949 in 2000 to 20,682 in 2012 [3]. It still causes significant morbidity and mortality [6,7] In recognition of this in 2005 the UK British Society of Gastroenterology (BSG) Working Party on Acute Pancreatitis released a revised version of their 1998 guidelines for best practice management of acute gallstone pancreatitis (GSP) 8. What is lacking in the literature is an assessment of the variation that exists between Trusts of varying size and structure at the national level and how these may impact patient outcomes These factors have been investigated in colorectal and breast cancer surgery with studies producing differing results [12,13,14,15,16]. Trends in early definitive treatment between trusts were examined and patient morbidity outcomes were calculated
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