A population-based evaluation of severity and mortality among transferred patients with acute pancreatitis

Gobind Anand, Susan M. Hutfless, Venkata S. Akshintala, Mouen A. Khashab, Anne Marie Lennon, Martin A. Makary, Kenzo Hirose, Dana Andersen, Anthony N. Kalloo, Vikesh K. Singh

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Objectives: This study aimed to compare severity of acute pancreatitis (AP) and mortality rates between transferred and nontransferred patients and to determine the factors that influence the decision to transfer.

Methods: A retrospective analysis coding a statewide administrative database in Maryland was conducted. Severity was defined by presence of organ failure (OF), need for intensive care unit (ICU), mechanical ventilation (MV), or hemodialysis.

Results: There were 71,035 discharges for AP, with 1657 (2.3%) patient transfers. Transferred patients had more multisystem OF (5.6% vs 1.2%), need for ICU (22.8% vs 4.3%), MV (13.1% vs 1.4%), hemodialysis (4.2% vs 2.7%), and higher mortality (6.1% vs 1.1%) compared with nontransferred patients (P <0.0001). After adjusting for disease severity, mortality was similar between the transferred patients and the non-transferred patients (OR, 1.37; 95% confidence interval, 0.96-1.97). Younger (OR, 0.99), African American (OR, 0.55), and uninsured (OR, 0.46) patients were less likely to be transferred, whereas patients with multisystem OF (OR, 3.5), need for ICU (OR, 2.3), or MV (OR, 2.1) were more likely to be transferred (P <0.0001).

Conclusions: Transferred patients with AP have more severe disease and higher overall mortality. Mortality is similar after adjusting for disease severity. Disease severity, insurance status, race, and age all influence the decision to transfer patients with AP.

Original languageEnglish (US)
Pages (from-to)1111-1116
Number of pages6
JournalPancreas
Volume43
Issue number7
StatePublished - 2014
Externally publishedYes

Fingerprint

Pancreatitis
Mortality
Population
Artificial Respiration
Intensive Care Units
Patient Transfer
Renal Dialysis
Insurance Coverage
African Americans
Databases
Confidence Intervals

Keywords

  • Acute pancreatitis
  • Mortality
  • Severity
  • Transfer

ASJC Scopus subject areas

  • Hepatology
  • Internal Medicine
  • Endocrinology
  • Endocrinology, Diabetes and Metabolism
  • Medicine(all)

Cite this

Anand, G., Hutfless, S. M., Akshintala, V. S., Khashab, M. A., Lennon, A. M., Makary, M. A., ... Singh, V. K. (2014). A population-based evaluation of severity and mortality among transferred patients with acute pancreatitis. Pancreas, 43(7), 1111-1116.

A population-based evaluation of severity and mortality among transferred patients with acute pancreatitis. / Anand, Gobind; Hutfless, Susan M.; Akshintala, Venkata S.; Khashab, Mouen A.; Lennon, Anne Marie; Makary, Martin A.; Hirose, Kenzo; Andersen, Dana; Kalloo, Anthony N.; Singh, Vikesh K.

In: Pancreas, Vol. 43, No. 7, 2014, p. 1111-1116.

Research output: Contribution to journalArticle

Anand, G, Hutfless, SM, Akshintala, VS, Khashab, MA, Lennon, AM, Makary, MA, Hirose, K, Andersen, D, Kalloo, AN & Singh, VK 2014, 'A population-based evaluation of severity and mortality among transferred patients with acute pancreatitis', Pancreas, vol. 43, no. 7, pp. 1111-1116.
Anand G, Hutfless SM, Akshintala VS, Khashab MA, Lennon AM, Makary MA et al. A population-based evaluation of severity and mortality among transferred patients with acute pancreatitis. Pancreas. 2014;43(7):1111-1116.
Anand, Gobind ; Hutfless, Susan M. ; Akshintala, Venkata S. ; Khashab, Mouen A. ; Lennon, Anne Marie ; Makary, Martin A. ; Hirose, Kenzo ; Andersen, Dana ; Kalloo, Anthony N. ; Singh, Vikesh K. / A population-based evaluation of severity and mortality among transferred patients with acute pancreatitis. In: Pancreas. 2014 ; Vol. 43, No. 7. pp. 1111-1116.
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abstract = "Objectives: This study aimed to compare severity of acute pancreatitis (AP) and mortality rates between transferred and nontransferred patients and to determine the factors that influence the decision to transfer.Methods: A retrospective analysis coding a statewide administrative database in Maryland was conducted. Severity was defined by presence of organ failure (OF), need for intensive care unit (ICU), mechanical ventilation (MV), or hemodialysis.Results: There were 71,035 discharges for AP, with 1657 (2.3{\%}) patient transfers. Transferred patients had more multisystem OF (5.6{\%} vs 1.2{\%}), need for ICU (22.8{\%} vs 4.3{\%}), MV (13.1{\%} vs 1.4{\%}), hemodialysis (4.2{\%} vs 2.7{\%}), and higher mortality (6.1{\%} vs 1.1{\%}) compared with nontransferred patients (P <0.0001). After adjusting for disease severity, mortality was similar between the transferred patients and the non-transferred patients (OR, 1.37; 95{\%} confidence interval, 0.96-1.97). Younger (OR, 0.99), African American (OR, 0.55), and uninsured (OR, 0.46) patients were less likely to be transferred, whereas patients with multisystem OF (OR, 3.5), need for ICU (OR, 2.3), or MV (OR, 2.1) were more likely to be transferred (P <0.0001).Conclusions: Transferred patients with AP have more severe disease and higher overall mortality. Mortality is similar after adjusting for disease severity. Disease severity, insurance status, race, and age all influence the decision to transfer patients with AP.",
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AU - Anand, Gobind

AU - Hutfless, Susan M.

AU - Akshintala, Venkata S.

AU - Khashab, Mouen A.

AU - Lennon, Anne Marie

AU - Makary, Martin A.

AU - Hirose, Kenzo

AU - Andersen, Dana

AU - Kalloo, Anthony N.

AU - Singh, Vikesh K.

PY - 2014

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N2 - Objectives: This study aimed to compare severity of acute pancreatitis (AP) and mortality rates between transferred and nontransferred patients and to determine the factors that influence the decision to transfer.Methods: A retrospective analysis coding a statewide administrative database in Maryland was conducted. Severity was defined by presence of organ failure (OF), need for intensive care unit (ICU), mechanical ventilation (MV), or hemodialysis.Results: There were 71,035 discharges for AP, with 1657 (2.3%) patient transfers. Transferred patients had more multisystem OF (5.6% vs 1.2%), need for ICU (22.8% vs 4.3%), MV (13.1% vs 1.4%), hemodialysis (4.2% vs 2.7%), and higher mortality (6.1% vs 1.1%) compared with nontransferred patients (P <0.0001). After adjusting for disease severity, mortality was similar between the transferred patients and the non-transferred patients (OR, 1.37; 95% confidence interval, 0.96-1.97). Younger (OR, 0.99), African American (OR, 0.55), and uninsured (OR, 0.46) patients were less likely to be transferred, whereas patients with multisystem OF (OR, 3.5), need for ICU (OR, 2.3), or MV (OR, 2.1) were more likely to be transferred (P <0.0001).Conclusions: Transferred patients with AP have more severe disease and higher overall mortality. Mortality is similar after adjusting for disease severity. Disease severity, insurance status, race, and age all influence the decision to transfer patients with AP.

AB - Objectives: This study aimed to compare severity of acute pancreatitis (AP) and mortality rates between transferred and nontransferred patients and to determine the factors that influence the decision to transfer.Methods: A retrospective analysis coding a statewide administrative database in Maryland was conducted. Severity was defined by presence of organ failure (OF), need for intensive care unit (ICU), mechanical ventilation (MV), or hemodialysis.Results: There were 71,035 discharges for AP, with 1657 (2.3%) patient transfers. Transferred patients had more multisystem OF (5.6% vs 1.2%), need for ICU (22.8% vs 4.3%), MV (13.1% vs 1.4%), hemodialysis (4.2% vs 2.7%), and higher mortality (6.1% vs 1.1%) compared with nontransferred patients (P <0.0001). After adjusting for disease severity, mortality was similar between the transferred patients and the non-transferred patients (OR, 1.37; 95% confidence interval, 0.96-1.97). Younger (OR, 0.99), African American (OR, 0.55), and uninsured (OR, 0.46) patients were less likely to be transferred, whereas patients with multisystem OF (OR, 3.5), need for ICU (OR, 2.3), or MV (OR, 2.1) were more likely to be transferred (P <0.0001).Conclusions: Transferred patients with AP have more severe disease and higher overall mortality. Mortality is similar after adjusting for disease severity. Disease severity, insurance status, race, and age all influence the decision to transfer patients with AP.

KW - Acute pancreatitis

KW - Mortality

KW - Severity

KW - Transfer

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