title: Acute biliary pancreatitis: focus on recurrence rate and costs when current guidelines are not complied.
abstract: BACKGROUND
  International guidelines recommend cholecystectomy within 2-4 weeks after mild to moderate acute biliary pancreatitis (ABP) to prevent recurrence. We aimed to investigate the compliance to guidelines concerning early cholecystectomy and the associated costs.
  
  
  METHODS
  Admissions for ABP 2011-2013 were retrospectively reviewed. Classification was made according to the revised Atlanta classification. Treatment, time to surgery and recurrence, as well as cost analysis for both in-hospital costs and loss of production (LOP) were performed.
  
  
  RESULTS
  In total, 254 patients were included. Some 202 of the ABP patients (80%) underwent definitive treatment during their first attack of ABP (68% cholecystectomy, 17% endoscopic retrograde cholangiopancreatography (ERCP), 15% both interventions) and 186 (73%) were treated within 1 month of discharge. Patients with ERCP alone were significantly older than cholecystectomy cases (p < .001), but no significant difference was observed between those who underwent ERCP or no treatment (p = .071). Mild ABP had intervention earlier (p < .001). In all, 52 patients (20%) had no intervention, out of which 15 were readmitted due to pancreatitis, compared to 3 patients of those treated at the initial admission (p < .001). The mean cost for hospital care and LOP in mild ABP was €6882 ± 3010 and €9580 ± 7047 for moderate ABP (p = .001). The cost for a recurrent episode was €16,412 ± 22,367.
  
  
  CONCLUSIONS
  By improved compliance to current guidelines concerning the management of ABP, recurrence rate and associated costs can potentially be reduced.
authors.affiliation: a Department of Surgery, Clinical Sciences Lund , Skane University Hospital, Lund University , Lund , Sweden.
authors.forename: Tim
authors.initials: T
authors.lastname: Ragnarsson
authors.affiliation: a Department of Surgery, Clinical Sciences Lund , Skane University Hospital, Lund University , Lund , Sweden.
authors.forename: Roland
authors.initials: R
authors.lastname: Andersson
authors.affiliation: a Department of Surgery, Clinical Sciences Lund , Skane University Hospital, Lund University , Lund , Sweden.
authors.forename: Daniel
authors.initials: D
authors.lastname: Ansari
authors.affiliation: b School of Economics , The Swedish Institute for Health Economics Lund , Lund , Sweden.
authors.forename: Ulf
authors.initials: U
authors.lastname: Persson
authors.affiliation: a Department of Surgery, Clinical Sciences Lund , Skane University Hospital, Lund University , Lund , Sweden.
authors.forename: Bodil
authors.initials: B
authors.lastname: Andersson
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000706:statistics & numerical data*; D002763:Cholecystectomy / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000191:economics* / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic; D013548:Sweden; D061665:Time-to-Treatment; D055815:Young Adult
keywords: Acute biliary pancreatitis; costs; loss of production; recurrence