Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] · 2025
Gallstone Pancreatitis: Clinical outcomes and economic impact at a tertiary UK Hepatobiliary centre.
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Fouad Mina, Aigbokhae Osarumwese, Sonoo Prithvirao, Quraishi Samah, Ibrahim Oladeji, Sanyal Sudip
Аннотация
BACKGROUND: Gallstone pancreatitis (GSP) accounts for nearly 50 % of acute pancreatitis admissions in the NHS. Post-COVID-19 delays in laparoscopic cholecystectomy (LC) have amplified the clinical and financial burden. This study evaluates outcomes and preventable costs associated with GSP at a UK tertiary centre.
METHOD: A prospective cohort of 185 GSP patients was analysed over 30 months at Nottingham University Hospitals NHS Trust. Patients were stratified into three age groups: 20-49, 50-69, and ≥70 years. Data included demographics, disease severity, LC timing, readmissions, and healthcare costs.
RESULTS: The median length of hospital stay was 4 days (IQR: 2-7), increasing slightly with age and disease severity. Severe pancreatitis occurred in 29.2 % of patients aged ≥70. ICU admissions were highest in the 50-69 years group (9.7 %), with mortality and complication rates peaking in those ≥70 years (16.7 % and 19.4 %, respectively). Median LC waiting times increased through age groups: 61.0, 100.0, and 272.0 days, respectively. Readmission rates rose progressively with age, reaching 43.1 % in the oldest group. Delays beyond 121 days were associated with higher readmission risk. Hot cholecystectomy was most frequent in younger patients (15.7 %). The total cost of inpatient care for GSP reached £1.12 million (median cost of £6663 per patient). Readmissions accounted for 58 % of the total cost (£4250 per episode).
CONCLUSIONS: Readmission-related expenditure, largely preventable with timely surgery, represents a key target for intervention. Prioritising early cholecystectomy, particularly within 121 days of index admission, may substantially reduce the financial burden and improve patient outcomes across the NHS.
METHOD: A prospective cohort of 185 GSP patients was analysed over 30 months at Nottingham University Hospitals NHS Trust. Patients were stratified into three age groups: 20-49, 50-69, and ≥70 years. Data included demographics, disease severity, LC timing, readmissions, and healthcare costs.
RESULTS: The median length of hospital stay was 4 days (IQR: 2-7), increasing slightly with age and disease severity. Severe pancreatitis occurred in 29.2 % of patients aged ≥70. ICU admissions were highest in the 50-69 years group (9.7 %), with mortality and complication rates peaking in those ≥70 years (16.7 % and 19.4 %, respectively). Median LC waiting times increased through age groups: 61.0, 100.0, and 272.0 days, respectively. Readmission rates rose progressively with age, reaching 43.1 % in the oldest group. Delays beyond 121 days were associated with higher readmission risk. Hot cholecystectomy was most frequent in younger patients (15.7 %). The total cost of inpatient care for GSP reached £1.12 million (median cost of £6663 per patient). Readmissions accounted for 58 % of the total cost (£4250 per episode).
CONCLUSIONS: Readmission-related expenditure, largely preventable with timely surgery, represents a key target for intervention. Prioritising early cholecystectomy, particularly within 121 days of index admission, may substantially reduce the financial burden and improve patient outcomes across the NHS.