The influence of treatment access regulation and technological resources on the mortality profile of acute biliary pancreatitis.
OBJECTIVE
The influence of treatment access regulation and technological resources on the mortality profile of acute biliary pancreatitis (ABP) was evaluated.


METHODS
The cases seen in a tertiary hospital were studied during two periods of time: 1995-1999 and 2000-2004, i.e., before and after the implementation of medical regulation.


RESULTS
Among the 727 patients with acute pancreatitis, 267 had ABP and were classified according to APACHE II scores. The cases being referred to the tertiary hospital decreased from 441 to 286 (p < 0.001). The patients' profile regarding age, gender, severity, cholestasis incidence and mortality were similar during the first and second periods of study (n = 154 and n = 113, respectively). The number of patients with hematocrit > or =44% was smaller during the second study period (p<0.002). The use of magnetic resonance cholangiography, videolaparoscopic cholecystectomy, and access to the ICU were found to be more frequent during the second study period. Regarding the deaths occurring within 14 days of hospitalisation, 73.4% and 81.3% were observed during the first and second study periods, respectively.


CONCLUSIONS
Since the improvement in clinical and technological approach was not enough to modify the mortality profile of ABP, further studies on the treatment of inflammatory responses should be carried out.
Division of Digestive Surgery, Department of Surgery and Anatomy, Ribeirão Preto Faculty of Medicine, University of São Paulo, SP, Brazil. frcneto@terra.com.br
Francisco Ribeiro de
FR
Carvalho
José Sebastião dos
JS
Santos
Jorge
J
Elias Junior
Rafael
R
Kemp
Ajith Kumar
AK
Sankarankutty
Olívia Yumi
OY
Fukumori
Manoel Carlos L de Azevedo
MC
Souza
Orlando de
Od
Castro-e-Silva
D018806:APACHE; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D002758:Cholangiography / Q000379:methods* / Q000401:mortality; D002763:Cholecystectomy / Q000379:methods* / Q000401:mortality; D002769:Cholelithiasis / Q000401:mortality* / Q000628:therapy; D003422:Critical Care / Q000706:statistics & numerical data; D005189:False Positive Reactions; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000401:mortality* / Q000628:therapy; D012680:Sensitivity and Specificity; D055815:Young Adult