Have acute pancreatitis? Go to a big hospital

Suffering from acute pancreatitis but not sure where to go? You may want to head to a hospital that handles a lot of similar cases.

New research suggests that patients who go to hospitals that admit 118 or more people with pancreatitis each year experience shorter stays and lower death rates, and have lower hospital bills than patients who go to hospitals that admit fewer than 118 people with pancreatitis each year.

In general, the hospitals dealing with more pancreatitis cases tended to be larger, urban, research centers and serve a greater black or Hispanic population.

The findings, which appear in the journal Gastroenterology, are based on a review of more than 416,000 cases of acute pancreatitis treated in US hospitals from 1998-2006.

Dr. Shimul A. Shah of the University of Massachusetts Medical School in Worcester and colleagues say reasons for the difference in outcomes from low- and high-volume hospitals may have to do with the availability of intensive care, specialists, and the latest technology at the various hospitals.

Given the rising incidence of acute pancreatitis and the reported costs exceeding $2 billion annually in the United States, our study suggests that referral of complicated cases of acute pancreatitis to high-volume centers should be discussed at a policy level, Shah and colleagues conclude.

Similar policy decisions have been made for other diseases, Dr. Bechien U. Wu from Harvard Medical School, Boston wrote in a commentary. For example, the Center for Medicare and Medicaid Services only reimburses bariatric surgery if performed at certain Centers of Excellence.

What is different about treatment of acute pancreatitis, however, is that it is an illness that requires both medical and surgical treatment; benefits of larger-hospital treatment have so far held true only for surgical interventions.

Wu suggests that a next step for research would be to determine when referral of a patient with acute pancreatitis to a larger hospital might provide the most benefit.

We are not suggesting that all patients should go to high-volume centers, Shah wrote in an email to Reuters Health. What the study does suggest, Shah added, is that there is a subset of patients that would benefit from treatment at a hospital that treats a larger number of patients with acute pancreatitis.

SOURCE: Gastroenterology, December 2009.