Mortality and recurrence risk after a first episode of acute pancreatitis in the elderly: population-based study

Abstract

BackgroundImproved standard of living and advances in medical care have increased longevity in Sweden and the rest of the Western world. Increased longevity has led to an increase in the proportion of the population older than 80 years. At the same time, the incidence of first-time acute pancreatitis among those aged at least 80 years has increased [1][2][3][4] .Gallstone disease and alcohol are the main causes of acute pancreatitis in the adult population 1,5 . In the elderly, however, gallstone disease is the most common aetiology 2,6-9 . In biliary acute pancreatitis, cholecystectomy or endoscopic retrograde cholangiopancreatography (ERCP) is recommended to prevent recurrent episodes of acute pancreatitis. However, there is a risk of serious adverse events from these interventions in elderly patients with high co-morbidity. Several studies [10][11][12] have shown that the co-morbidity level influences outcome in acute pancreatitis.Whether age itself is a risk factor in acute pancreatitis is debated. Many studies of elderly patients with acute pancreatitis have been conducted over the past decade. However, it is difficult to draw any definite conclusions from these because different cut-off values have been used for age. Studies have come to divergent conclusions, some 7,13,14 that age is an independent risk factor and others 15 that it is not.The objective of the present study was to evaluate the mortality of patients aged 80 years or more treated for acute pancreatitis, as well as mortality related to interventions aimed at preventing recurrent biliary pancreatitis. A second aim was to explore the risk of recurrent pancreatitis in elderly patients who had undergone ERCP or cholecystectomy.