Abstract
BackgroundVery 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.MethodsSystematic 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.ResultsMortality 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.ConclusionsAlthough 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.
Highlights
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
Size of hospital In the four large hospitals, compared with small hospitals, we found some evidence of increased mortality of 53% for acute pancreatitis overall and 69% for gallstone aetiology, but comparable mortality between small and medium size hospitals
European working time directives We found little evidence overall that the two EWTDs have had a significant impact on patient mortality following acute pancreatitis up to the end of 2010, mortality was increased during August 2004 for alcoholic acute pancreatitis
Summary
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. There is large variation in mortality following emergency admissions, including acute pancreatitis, across hospitals in the UK [2,3,10] Some of this variation is explained by patient case mix, there is major concern that it may be linked to factors such as changes in junior doctor’s working hours, recruitment of newly qualified doctors in August each year, the week day of admission and the hospital size. There are concerns about whether the recruitment of newly qualified junior doctors each August affects patient care and outcomes [13], but this has not been reported for acute pancreatitis
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