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.

Zusammenfassung

Hintergrund Die akute Pankreatitis (AP) ist eine der häufigsten gastrointestinalen Erkrankungen. Insbesondere die komplizierten Krankheitsverläufe stellen immer noch eine große klinische Herausforderung dar und sind mit einer hohen Mortalität verbunden. Die Auswertung vorhandener Datensätze und deren sorgfältige Interpretation kann eine rationale Diskussion mit dem Ziel einer optimierten Behandlung dieser häufigen gastrointestinalen Erkrankung unterstützen.

Methoden Standardisierte Krankenhausentlassungsdaten des Statistischen Bundesamtes wurden verwendet, um die Krankenhaussterblichkeit sowie aktuelle Entwicklungen der AP in Deutschland zwischen 2008 und 2017 zu evaluieren.

Ergebnisse Es wurden 516,618 hospitalisierte AP-Fälle eingeschlossen. Die häufigsten Krankheitsursachen waren die biliäre (29,9%) und alkoholische (22,7%) AP. Die jährliche Inzidenz der AP stieg von 48,858 (2008) auf 52,611 (2017) an, was hauptsächlich auf eine steigende Inzidenz der biliären AP zurückzuführen war. Die durchschnittliche Krankenhausmortalität betrug 2,85% und verbesserte sich im Laufe des Untersuchungszeitraumes deutlich. Während die unkomplizierte AP durch eine niedrige Krankenhausmortalität (1,38%) gekennzeichnet war, führte das Vorhandensein einer Organkomplikation zu einer Sterblichkeit von 12,34%. Darüber hinaus erhöhte die Notwendigkeit einer künstlichen Beatmung die Krankenhaussterblichkeit drastisch auf 44.06%. Die Mortalität war bei Patientinnen (3,31%) signifikant höher als bei Patienten (2,55%) und nahm schrittweise mit dem Patientenalter ab. Darüber hinaus identifizierten wir Typ-2 Diabetes und Adipositas als Faktoren, die mit einer erhöhten Krankenhausmortalität verbunden sind. Die Krankenhaussterblichkeit war am niedrigsten bei Patienten, die in gastroenterologischen Abteilungen behandelt wurden. Schließlich wiesen Zentren mit hohem Fallvolumen (definiert als >98 AP-Fälle pro Jahr) die niedrigste Krankenhausmortalität bei Patienten mit komplizierten Verläufen der AP auf.

Schlussfolgerung Mit über 50,000 jährlichen Krankenhauseinweisungen ist die AP eine der wichtigsten stationären Behandlungsindikationen der Gastroenterologie in Deutschland. Die Gesamtmortalität der AP hat sich in den letzten Jahren verbessert, was vermutlich auf verbesserte interdisziplinäre Behandlungskonzepte zurückzuführen ist. In dieser Studie konnten wir wichtige klinische und epidemiologische Risikofaktoren für einen ungünstigen Verlauf identifiziert, die dabei helfen könnten, die Risikovorhersage, die Triage und somit das Management der AP zu verbessern.

Schlüsselwörter

AP - biliär - alkoholisch - DRG - ICD-10

Keywords

AP - biliary - alcoholic - DRG - ICD-10

Publication History

Received: 24 August 2021

Accepted after revision: 24 October 2021

Article published online:
24 November 2021

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