Current epidemiological trends and in-hospital mortality of acute pancreatitis in Germany: a systematic analysis of standardized hospital discharge data between 2008 and 2017

Abstract

Background Acute pancreatitis (AP) represents a common gastrointestinal disorder. Complicated disease courses in particular still represent a major clinical challenge and are associated with high mortality. Evaluation of existing data sets and their careful interpretation can support a rational discussion to optimize outcomes of this common gastrointestinal disease. Methods We used standardized hospital discharge data provided by the Federal Statistical Office of Germany to evaluate hospital mortality and current developments of AP in Germany between 2008 and 2017. Results In this analysis, 516,618 hospitalized AP cases were included. Main disease etiologies featured biliary (29.9%) and alcoholic (22.7%) AP. The annual frequency of AP increased from 48,858 (2008) to 52,611 (2017), mainly due to a rising incidence of biliary AP. Average hospital mortality was 2.85% and significantly improved over time. While uncomplicated AP had low hospital mortality (1.38%), the presence of organ complications was associated with a mortality of 12.34%. The necessity of mechanical ventilation dramatically increased hospital mortality to 44.06%. Hospital mortality was significantly higher in female patients (3.31%) than males (2.55%) and showed a stepwise increase with patient age. We further identified type 2 diabetes mellitus and obesity as factors associated with increased hospital mortality. Hospital mortality was lowest among patients treated at departments specializing in gastroenterology. Finally, high case volume centers (defined as >98 annual AP cases) had the lowest hospital mortality for patients with complicated courses of AP. Conclusion With over 50,000 annual hospitalization cases, AP is one of the most important inpatient treatment indications in gastroenterology in Germany. Overall, AP mortality has improved in recent years, presumably due to improved interdisciplinary treatment concepts. In this study, we identified important clinical and epidemiological risk factors for an unfavorable course, which could help to improve risk prediction and triaging, and thus the management of AP.

Clinical determinants of hospital mortality in liver failure: a comprehensive analysis of 62,717 patients

“…Moreover, patients treated in a gastroenterology clinic had the lowest mortality (26.1 %), even when compared with general internal medicine clinics (38.8 %). These data are consistent with other studies showing a lower mortality in specialised centres [25] and further support the hypothesis of lower mortality of LF at specialised centres.…”

“…Our analyses further provided evidence for an inverse correlation between the hospitals' annual LF case volume and hospital mortality. The association between case volume and patients' outcome was established for a variety of gastrointestinal conditions and procedures including upper GI bleeding [50], acute pancreatitis [25] or liver transplantation. In our cohort, hospital mortality of LF was almost 50 % in patients treated at a low case volume centre (LCV: 1-5 LF cases/year) and significantly decreased to less than 30 % in LF patients treated at a high case volume centre (HCV: > 26 LF cases/year).…”

“…Ascites [17], systemic (sepsis) or local infections (spontaneous bacterial peritonitis) [18] and hepatic encephalopathy [19,20], as well as renal [21,22] and lung failure [23], are discussed as key factors associated with an increased mortality of acute and chronic LF. In addition, hospital mortality of liver failure could depend on the hospital annual case volume as observed in other acute gastrointestinal diseases [24,25]. However, there is a lack of large-scale data on recent development and hospital mortality of LF in the Western world and in Germany in particular.…”