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Novel multidisciplinary hub-and-spoke tertiary service for the management of severe acute pancreatitis

Lookup NU author(s): Dr Manu Nayar, David Bourne, Professor John LeedsORCiD, Professor Kofi Oppong, Gourab Sen, Jeremy French, Professor Sanjay PandanaboyanaORCiD, Richard Charnley

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Abstract

© Objective: Severe acute pancreatitis (SAP) is associated with high mortality (15%-30%). Current guidelines recommend these patients are best managed in a multidisciplinary team setting. This study reports experience in the management of SAP within the UK's first reported hub-and-spoke pancreatitis network. Design: All patients with SAP referred to the remote care pancreatitis network between 2015 and 2017 were prospectively entered onto a database by a dedicated pancreatitis specialist nurse. Baseline characteristics, aetiology, intensive care unit (ICU) stay, interventions, complications, mortality and follow-up were analysed. Results: 285 patients admitted with SAP to secondary care hospitals during the study period were discussed with the dedicated pancreatitis specialist nurse and referred to the regional service. 83/285 patients (29%; 37 male) were transferred to the specialist centre mainly for drainage of infected pancreatic fluid collections (PFC) in 95% (n=79) of patients. Among the patients transferred; 29 (35%) patients developed multiorgan failure with an inpatient mortality of 14% (n=12/83). The median follow-up was 18.2 months (IQR=11.25-35.51). Multivariate analysis showed that transferred patients had statistically significant longer overall hospital stay (p<0.001) but less ICU stay (p<0.012). Conclusion: This hub-and-spoke model facilitates the management of the majority of patients with SAP in secondary care setting. 29% warranted transfer to our tertiary centre, predominantly for endoscopic drainage of PFCs. An evidence-based approach with a low threshold for transfer to tertiary care centre can result in lower mortality for SAP and fewer days in ICU.

Publication metadata

Author(s): Nayar MK, Bekkali NLH, Bourne D, Young S, Leeds JS, Oppong KW, Logue JL, Sen G, French JJ, Scott J, Cressey D, Pandanaboyana S, Charnley RM

Publication type: Article

Publication status: Published

Journal: BMJ Open Gastroenterology

Year: 2021

Volume: 8

Issue: 1

Online publication date: 31/03/2021

Acceptance date: 28/02/2021

Date deposited: 22/04/2021

ISSN (electronic): 2054-4774

Publisher: BMJ Publishing Group

URL: https://doi.org/10.1136/bmjgast-2020-000501

DOI: 10.1136/bmjgast-2020-000501

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