Green R et al. – The current study determined the appropriateness of compliance with early definitive care, defined as cholecystectomy or endoscopic sphincterectomy at admission or within 2 weeks of discharge, as a parameter for quality of care in patients with acute gallstone pancreatitis. The authors observed variation in compliance with recommended early definitive treatment and associated variation in outcomes. They concluded that compliance should be considered as a quality indicator of care to improve care.

Methods

• This retrospective cohort study enrolled acute gallstone pancreatitis patients admitted to National Health Services Hospitals between 2008 and 2010 after first diagnosis of the indication.
• Data were collected from the hospital episode statistics database.
• The study evaluated the trends for early definitive treatment between hospital trusts along with patient morbidity outcomes.

Results

• Data of 19,510 patients was evaluated with an overall rate of early definitive treatment at 34.7% (range 9.4%–84.7%).
• During the 1–year follow–up, 4661 patients (23%) were readmitted for acute gallstone pancreatitis–related complications.
• Acute pancreatitis readmissions constituted of 57.8% (n = 2692 patients) of the total acute gallstone pancreatitis readmissions. Of the 2692, 911 patients (33.8 %) were readmitted within first 2 weeks of discharge, whereas the 1781 patients (66.2%) occurred beyond the optimal time for receiving definitive treatment.
• Readmission risk reduced by 39% with early definitive treatment (adjusted risk ratio [RR] 0.61, 95% CI 0.58–0.65) and to 54% in acute pancreatitis patients (adjusted RR 0·46, 95% CI 0·42–0·51).