Outcome of acute pancreatitis in octogenarians: A retrospective study

Abstract

Background and Aim Acute pancreatitis (AP) is a common disease, but data on outcomes in octogenarians are scarce in the literature. The aim of this study is to analyze results from patients aged 80 years old and over who were treated for AP at a single center. Methods Patients aged 80 years and older diagnosed with AP from April 2010 to October 2015 were considered. Demographics, American Society of Anesthesiologists (ASA) score, Charlson Comorbidity Index (CCI), serum biochemistry at 24 and 48 h after admission, and revised Atlanta severity score were analyzed and correlated with hospital mortality rate and length of stay using the multiple regression and Kaplan–Meier tests. Results A total of 100 consecutive patients were included in the study. There were 52 women, and the mean age was 87.5 years (range 80–95). Gallstones were the most common cause of AP (69.7%). The ASA score was ≥III in 51 patients. Eight patients had severe, disease and all of them died in hospital. A CCI > 4 was associated with higher disease severity and mortality (P < 0.00001). The median hospital stay was 9 days (range 1–59). Longer hospital stay was associated with serum C‐reactive protein ≥242 mg/L (P = 0.01) and serum albumin ≤30 g/L (P = 0.01) at 48 h. Over a 5‐year period, 22% of patients were readmitted to hospital with recurrent AP. Gallstones were the main cause of disease (63.6%). Conclusions AP in octogenarians has low mortality. Higher death rate is associated with disease severity. In the presence of gallstone disease, cholecystectomy is recommended whenever possible as the risk of disease recurrence is significant.

Long-term outcome of patients with biliary pancreatitis not undergoing cholecystectomy. A retrospective study

“…It is not always easy to determine the correct risk-benefit balance of having surgery in this scenario. Previous reports have shown that many patients are deemed too frail to undergo either general anesthesia or any surgical procedure, and never undergo cholecystectomy following biliary pancreatitis (16). Conversely, a recent British national cohort study revealed that the CCI of the patients not having undergone surgery after biliary events was higher and, according to our results, gallbladder-related deaths were still significantly lower than all other causes of death in the non-surgical group (17).…”

Clinical evaluation of the severity of acute pancreatitis in elderly patients

“…Another study by Di Mauro et al found that a Charlson comorbidity index >4 was associated with higher disease severity and mortality in AP patients. They also suggested that, if feasible, cholecystectomy should be considered for elderly patients with gallstones (12). Murata et al demonstrated that comorbidities in elderly AP patients were associated with longer hospital stays and in-hospital mortality, with cardiovascular and renal diseases being particularly linked to mortality (13).…”