M. Magarakis1, N. M. Vranis1, B. Bruns1, R. B. Tesoriero1, S. Sivaraman1, C. A. Sadler1, H. Desai1, J. Diaz1 1University Of Maryland,Acute Care Emergency Surgery,Baltimore, MD, USA
Introduction:
Hospital admissions for Acute Pancreatitis in the United States exceed 300.000 per year, with annual costs of 2 billion dollars. Approximately 15-25% of patients develop a severe course with mortality as high as 50%. Predicting which patients will require surgical intervention remains challenging, and delays to definitive care may worsen outcomes. We aimed to identify risk factors that predict the need for surgical intervention (SI) in this patient population
Methods:
A retrospective review of patients admitted with acute pancreatitis from January 2011 to December 2013 was performed from a prospectively collected Emergency General Surgery Registry. Charts were reviewed for patient demographics, admission type, laboratory values, etiology of pancreatitis, CT severity index, presence of pancreatic necrosis or infection, ICU length of stay, development of organ failure, and need for SI
Results:
386 patients were admitted with acute pancreatitis. There were 68% males and 32% females. Fifty-eight patients received SI. Using multivariable regression analysis, factors associated with SI included: direct admission (OR=3.6, 95% CI 1.3, 9.7, p<0.05), WBC>16 (OR=2.8, 95% CI 1.2, 6.6, p<0.05), respiratory failure (OR=5.5, 95% CI 2.3, 13.4, p<0.001), and presence of necrosis/infection (OR=9.3, 95% CI 3.4, 25.2, p<0.0001)
Conclusion:
Acute pancreatitis is a complex disease with an unpredictable course. Identification of patients who will require SI remains difficult despite multiple severity classification systems. In our review; direct admission, WBC > 16, presence of respiratory failure, and pancreatic necrosis/infection significantly increased the odds of receiving SI. Identification of risk factors for SI may allow more time efficient surgical consultation/admission and improve outcomes