Background and aim: The data regarding the differences in outcome after acute biliary pancreatitis in elderly patients are scarce. This study aims to evaluate the outcome and radiological presentation in patients over 70 years after acute biliary pancreatitis.
Methods: Between January 2006 and December 2012, a retrospective analysis was performed on all consecutive patients with acute biliary pancreatitis admitted to the
university hospital (CHUV) in Lausanne (Switzerland). Patients were divided into 2 groups: >70 years (elderly group) and <70 years (control group). The severity of patients' comorbidities was assessed according to the Charlson score. Data analysed included clinical (Atlanta classification) and radiological severity (Baltazar score, computed tomography severity index) of the acute pancreatitis.
Results: A total of 214 patients (n=77 elderly group, n=137 control group) were included. The elderly group had a mean age of 80 years (control group 45 years, p<0.001). The
elderly had a higher Charlson score at admission (p<0.001). According to the Atlanta classification, there was no difference in the clinical severity of the pancreatitis between young and elderly patients, and the majority had a mild acute pancreatitis (66% vs. 64%, p=0.857). The elderly required more ERCP (39% vs. 20%, p=0.004) and percutaneous/endoscopic drainage of infected collection (12% vs. 4%, p=0.039). The rate of portal vein thrombosis was higher in the elderly (10% vs. 2%, p=0.005). The elderly had a longer hospital stay (10 vs. 7 days, p<0.001), while the ICU length of stay was similar in both groups. The 90-day mortality was similar in both groups.
Conclusions: Despite higher comorbidities at admission, elderly patients have similar clinical severity and mortality as young patients after acute biliary pancreatitis. However,
the natural history of the disease seems different in the elderly with higher rates of infected collections requiring invasive procedures, and a higher rate of portal vein thrombosis.