The influence of treatment access regulation and technological resources on the mortality profile of acute biliary pancreatitis

Abstract

PURPOSE: The influence of treatment access regulation and technological resources on the mortality profile of acute biliary pancreatitis (ABP) was evaluated. METHODS: The cases seen in a tertiary hospital were studied during two periods of time: 1995-1999 and 2000-2004, i.e., before and after the implementation of medical regulation. RESULTS: Among the 727 patients with acute pancreatitis, 267 had ABP and were classified according to APACHE II scores. The cases being referred to the tertiary hospital decreased from 441 to 286 (p < 0.001). The patients' profile regarding age, gender, severity, cholestasis incidence and mortality were similar during the first and second periods of study (n = 154 and n = 113, respectively). The number of patients with hematocrit > 44% was smaller during the second study period (p<0.002). The use of magnetic resonance cholangiography, videolaparoscopic cholecystectomy, and access to the ICU were found to be more frequent during the second study period. Regarding the deaths occurring within 14 days of hospitalisation, 73.4% and 81.3% were observed during the first and second study periods, respectively. CONCLUSION: Since the improvement in clinical and technological approach was not enough to modify the mortality profile of ABP, further studies on the treatment of inflammatory responses should be carried out.

First attack of acute pancreatitis in Sweden 1988 – 2003: incidence, aetiological classification, procedures and mortality – a register study

“…The need to identify cost-effective strategies to prevent and treat acute pancreatitis has been emphasized [26-28] and our study underlines this. In agreement with previous studies [5] we found that CFR (and SMR) decreased in recent years.…”

Colecistectomia: Aspectos Técnicos E Indicações Para O Tratamento Da Litíase Biliar E Das Neoplasias

“…Na avaliação de 267 casos de PAB tratado no Hospital das Clínicas de Ribeirão Preto entre 1995 a 2004, a mortalidade geral foi de 11,6%, pouco acima do limite superior registrado na literatura para a pancreatite aguda quando se considera todas as etiologias (variação de 2 a 9%). Na PAB branda a mortalidade geral observada foi de 3,8%, 41 semelhante aos achados da literatura, em média, de 3%, com variação de 1 a 7%. 43 Nesse estudo, a mortalidade geral para a PAB grave foi de 27,9%, 39 e está dentro dos limites observados na literatura; de 8% a 39%, com média de 17%.…”

Conservative management of cholestasis with and without fever in acute biliary pancreatitis

“…Within the context of the dynamic and diverse course of ABP patients with different care needs and of the management of patient flow, the definition of priorities and the appropriate access to services, resources and specialists are a challenge and may impair the application of the clinical decisions recommended in protocols and consensuses [19,[42][43][44][45] . Conservative treatment of ABP with cholangitis, similar to what occurs in cases without cholangitis, shows rates of spontaneous clearance of the common bile duct within two weeks of approximately 70%.…”

“…However, a response to clinical treatment occurs in 80% of cases and the need for urgent biliary disobstruction is rare [40,41] . These observations coupled with the characteristics of public health systems and possible access to a reference hospital and its services have definitely influenced the management of ABP cases associated with and without cholangitis [42,43] .…”