title: Hospital admission volume does not impact the in-hospital mortality of acute pancreatitis.
abstract: Multiple factors influence mortality in Acute Pancreatitis (AP).
  
  
  
  To evaluate the association of demographic, clinical, and hospital factors with the in-hospital mortality of AP using a population-based administrative database. The Maryland HSCRC database was queried for adult (≥18 years) admissions with primary diagnosis of AP between 1/94-12/10. Organ failure (OF), interventions, hospital characteristics and referral status were evaluated.
  
  
  
  There were 72,601 AP admissions across 48 hospitals in Maryland with 885 (1.2%) deaths. A total of 1657 (2.3%) were transfer patients, of whom 101 (6.1%) died. Multisystem OF was present in 1078 (1.5%), of whom 306 (28.4%) died. On univariable analysis, age, male gender, transfer status, comorbidity, OF, all interventions, and all hospital characteristics were significantly associated with mortality; however, only age, transfer status, OF, interventions, and large hospital size were significant in the adjusted analysis. Patients with commercial health insurance had significantly less mortality than those with other forms of insurance (OR 0.65, 95% CI: 0.52, 0.82, p = 0.0002).
  
  
  
  OF is the strongest predictor of mortality in AP after adjusting for demographic, clinical, and hospital characteristics. Admission to HV or teaching hospital has no survival benefit in AP after adjusting for OF and transfer status.
authors.affiliation: Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Ayesha
authors.initials: A
authors.lastname: Kamal
authors.affiliation: Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Amitasha
authors.initials: A
authors.lastname: Sinha
authors.affiliation: Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Hutfless
authors.affiliation: Center for Digestive Diseases, Cedars-Sinai Medical Center in Los Angeles, CA, USA.
authors.forename: Elham
authors.initials: E
authors.lastname: Afghani
authors.affiliation: Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Mahya
authors.initials: M
authors.lastname: Faghih
authors.affiliation: Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Mouen A
authors.initials: MA
authors.lastname: Khashab
authors.affiliation: Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Lennon
authors.affiliation: Division of Gastroenterology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Dhiraj
authors.initials: D
authors.lastname: Yadav
authors.affiliation: Pancreatitis Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Surgical Oncology, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Martin A
authors.initials: MA
authors.lastname: Makary
authors.affiliation: National Institutes of Digestive and Kidney Disease, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Dana K
authors.initials: DK
authors.lastname: Andersen
authors.affiliation: Pancreatitis Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Anthony N
authors.initials: AN
authors.lastname: Kalloo
authors.affiliation: Pancreatitis Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: vsingh1@jhmi.edu.
authors.forename: Vikesh K
authors.initials: VK
authors.lastname: Singh
mesh_terms: D000208:Acute Disease; D000367:Age Factors; D016208:Databases, Factual; D005260:Female; D006276:Health Facility Size / Q000639:trends*; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D008396:Maryland; D009102:Multiple Organ Failure / Q000401:mortality; D010195:Pancreatitis / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D010343:Patient Admission / Q000639:trends*; D010360:Patient Transfer / Q000639:trends; D017064:Process Assessment, Health Care / Q000639:trends*; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome