Changing patterns of incidence and mortality from acute pancreatitis in Scotland, 1961–1985

Abstract

Data on all discharges from hospitals in Scotland have been recorded since 1961 as the Scottish Hospital In-Patient Statistics and examination of these data has permitted analysis of the incidence and mortality trends from acute pancreatitis. The number of discharges recorded has increased 11-fold in males from 69 patients/year in 1961 to 750 patients/year in 1985, and fourfold in females from 112 patients/year to 484 patients/year respectively. This increase has occurred particularly amongst young and middle-aged males (20-59 years) and in elderly females (over 60 years), the most marked increases occurring in the health boards of the 'central belt' area of Scotland. Mortality rate did not show a corresponding change, increasing only two-fold in males from 15 patients/year to 30 patients/year and in females from 29 patients/year to 37 patients/year. As a consequence the case mortality rate has fallen from 17.8 per cent over the period 1961-65 to 5.6 per cent over the period 1981-85. An apparent increase in the incidence of acute pancreatitis may be inferred from these data, much of which is thought to be due to improved accuracy in diagnosis.

Fatal acute pancreatitis

“…These data compare well with what has been presented in another Swedish study [3] where 10 out of 31 deaths due to acute pancreatitis (32%) were identified from the forensic department and the patients were not ever admitted to hospital. In patients admitted to hospital but with an overlooked diagnosis obtained first at autopsy, the incidence of missed diagnosis has been reported as high as 30-42% [4,5]. It seems that a minority of these patients had abdominal pain at admission and that amylase was infrequently determined.…”

“…As acute pancreatitis represents a frequent condition with reported yearly incidences of approximately 30 patients per 100,000 inhabitants per year [3,4], the mortality encountered in the disease also represents a quantitative problem. Thirty to forty percent of patients with fatal acute pancreatitis have been reported diagnosed first at autopsy [4,5,7].…”

“…As acute pancreatitis represents a frequent condition with reported yearly incidences of approximately 30 patients per 100,000 inhabitants per year [3,4], the mortality encountered in the disease also represents a quantitative problem. Thirty to forty percent of patients with fatal acute pancreatitis have been reported diagnosed first at autopsy [4,5,7]. It seems that two peaks of mortality exist in patients admitted due to acute pancreatitis with an early mortality due to the effects of systemic inflammatory response syndrome (SIRS) and multiorgan dysfunction syndrome (MODS) while a late mortality is caused by the effects of MODS combined with 'pancreatic' sepsis following the gradual infection of pancreatic and peripancreatic necrosis [8,9].…”

Pancreatic diseases

“…20 Epidemiology: The true incidence of acute pancreatitis remains difficult to ascertain, primarily because of descriptive anomalies as previously stated, but also 21,22 There is evidence to suggest that the overall incidence is increasing and may reflect population changes in alcohol consumption and dietary habits. 23 A large epidemiological study involving 1068 cases from five countries in Europe over 4 years reported similar incidence and mortality rates between the participating countries, but found regional variations in the underlying causes. Alcohol was the most frequent aetiology in northern, and gallstones in southern countries.…”

Implementation of a novel emergency surgical unit significantly improves the management of gallstone pancreatitis

“…Twenty per cent of patients develop a severe attack with organ failure or other complications and there is an associated overall mortality rate of 7%. [3][4][5] The risk of recurrent GSP occurs in as many as 31% of patients within the first two weeks of discharge; however, this is reduced significantly with timely definitive surgical management or endoscopic treatment in those unfit for surgery. 6 The British Society of Gastroenter- prevent recurrence of symptoms.…”