Reduction in mortality in severe acute pancreatitis: A time trend analysis over 16 years.

Abstract

The trend in the outcome of patients with acute pancreatitis (AP) as a result of evolving management practices is not known. To study and compare the outcomes of patients with AP at a tertiary care academic center over a period of 16 years. In a retrospective study on a prospectively acquired database of patients with AP, we analyzed time trends of severity and mortality of AP. The influence of determinants of severity [APACHE II score, organ failure (OF), infected pancreatic necrosis (IPN)], and management strategy on the actual and predicted mortality was assessed. The actual mortality was adjusted for severity to analyze the severity-adjusted mortality at different times as a reflection of management practices over time. A total of 1333 patients were studied. The number of patients hospitalized with AP has been increasing over time. The proportion of patients with severe AP also increased from 1997 to 2013 as shown by increasing incidence of organ failure and IPN (Spearman's rank correlation coefficient (ρ): OF ρ(17)=0.797, p<0.01; IPN ρ(17)=0.739, p<0.001), indicating an increasing referral of sicker patients. Consequently, the overall mortality has been increasing (ρ(17)=0.584; p=0.014). However, despite increasing severity of AP, the mortality adjusted for OF has decreased significantly (ρ(17)=-0.55, p=0.02). Even with increasing proportion of patients with severe AP, there has been a significant decrease in organ failure adjusted mortality due to AP suggesting improved management over years.