Conservative management of acute pancreatitis: complications and outcome in a community-based hospital.

OBJECTIVE

Acute pancreatitis remains a potentially life-threatening disease. Despite national and international consensus conferences, the management of acute pancreatitis still differs among hospitals and countries.

METHODS

This study analyzes the outcome of acute pancreatitis treated by a conservative strategy in a community-based hospital. The strategy followed a conservative interpretation of German consensus guidelines but did not determine medical decisions by a prospective protocol.

RESULTS

The analysis included 145 patients treated for acute pancreatitis in the St. Josef Hospital Oberhausen from 1998 to 2002. The etiology was alcoholic in 54.5% and biliary in 26.2% of patients (other causes, 18.6%). Only 1 patient died of septic multiorgan failure (mortality, 1/145; 0.7%). Severe complications occurred in only 22 patients, including renal failure (n = 7), ileus (n = 6), respiratory or cardiac failure (n = 7), need for surgery (n = 4), and sepsis (n = 11). Further complications included pneumonia, delirium, choledocholithiasis/cholecystitis, diabetes mellitus, convulsions, gastric/duodenal ulcers, and pericardial effusion. Of the 145 patients, 75 subjects had at least 1 complication. Fine-needle puncture, mechanical ventilation, hemoperfusion, and hemodialysis were rarely necessary. Computed tomography (CT) was performed in only 69 of 145 patients (47.6%) and showed pancreatic necrosis in 27 of the 69 patients. Maximal C-reactive protein during the first 72 hours and CT findings proved useful in predicting the outcome in univariate analyses. By logistic regression, however, complication rates were associated with Ranson score, but not with CT findings, C-reactive protein, sex, age, etiology, or serum enzymes.

CONCLUSIONS

A conservative management of acute pancreatitis in a community-based hospital results in a low rate of complications, mortality, and costs. Clinical assessment (eg, by Ranson score) is sufficient to predict the severity of pancreatitis in most patients. In this cohort, none of the patients were transferred to a specialized center over a 5-year period. Thus, almost all patients with acute pancreatitis can adequately and cost-effectively be cared for in community-based hospitals when following conservative guidelines.