Centralized Care For Acute Pancreatitis Significantly Improves Outcomes
Szilárd Gódi1, Bálint Erőss1,2, Zsuzsanna Gyömbér3, Andrea Szentesi2,3, Nelli Farkas2,4, Andrea Párniczky2,5, Patrícia Sarlós1,2, Judit Bajor1, József Czimmer1,2, Alexandra Mikó2, Katalin Márta2, Roland Hágendorn1, Zsolt Márton1, Zsófia Verzár6, László Czakó3, Zoltán Szepes3, Áron Vincze1,2*, Péter Hegyi1,2,3,7* on behalf of the Hungarian Pancreatic Study Group
1) 1st Department of Medicine, University of Pécs Medical School, 7624 Pécs,
2) Institute for Translational Medicine, University of Pécs Medical School, 7624 Pécs,
3) 1st Department of Medicine, University of Szeged, 6720 Szeged,
4) Institute of Bioanalysis, University of Pécs Medical School, 7624 Pécs, Hungary
5) Department of Gastroenterology, Heim Pál Children’s Hospital, 1098 Budapest,
6) Department of Emergency Medicine, University of Pécs School of Medicine, 7624 Pécs,
7) MTA-SZTE Momentum Gastroenterology Multidisciplinary Research Group, Hungary
Aims: In this observational study, we investigated whether specialized care improves outcomes for acute pancreatitis (AP).
Methods: Consecutive patients admitted to two university hospitals with AP were enrolled in this study between 1 January 2016 and 31 December 2016 (Center A: specialized center; Center B: general hospital). Data on demographic characteristics and AP etiology, severity, mortality and quality of care (enteral nutrition and antibiotic use) were extracted from the Hungarian Acute Pancreatitis Registry. An independent sample t-test, Mann–Whitney test, chi-squared test or Fisher’s test were used for statistical analyses. Costs of care were calculated and compared in the two models of care.
Results: There were 355 patients enrolled, 195 patients in the specialized center (Center A) and 160 patients in the general hospital (Center B). There was no difference in mean age (57.02 ±17.16 vs. 57.31 ±16.50 P=0.872) and sex ratio (56% males vs. 57% males, P=0.837) between centres, allowing a comparison without selection bias. Center A had lower mortality (n=2, 1.03% vs. n=16, 6.25%, p=0.007), more patients received enteral feeding (n=179, 91.8%, vs. n=36, 22.5%, p<0.001) and fewer patients were treated with antibiotics (n=85, 43.6% vs. n=123, 76.9%, p=0.001). In Center A the median length of hospitalization was shorter (Me 6, IQR 5–9 vs. Me 8, IQR 6–11, p=0.02) and the costs of care were by 25% lower.
Conclusion: Our data suggests that treatment of AP in specialized centers reduces mortality, length of hospitalization and thus might reduce the costs.
Key words: acute pancreatitis – costs – specialized center – outcome – mortality.
Abbreviations: ACG: American College of Gastroenterology; AP: Acute pancreatitis; ER: Emergency Unit; IAP/APA: International Association of Pancreatology and the American Pancreatic Association; ICU: Intensive Care Unit; LOH: Length of hospitalization; SD: Surgical Department; TIMD: Territorial Internal Medical Departments; TPC: Tertiary Pancreas Center.