RT Journal Article
SR Electronic
T1 Novel multidisciplinary hub-and-spoke tertiary service for the management of severe acute pancreatitis
JF BMJ Open Gastroenterology
JO BMJ Open Gastro
FD BMJ Publishing Group Ltd
SP e000501
DO 10.1136/bmjgast-2020-000501
VO 8
IS 1
A1 Manu K Nayar
A1 Noor L H Bekkali
A1 David Bourne
A1 Sophie Young
A1 John S Leeds
A1 Kofi W Oppong
A1 Jennifer L Logue
A1 Gourab Sen
A1 Jeremy J French
A1 John Scott
A1 David Cressey
A1 Sanjay Pandanaboyana
A1 Richard M Charnley
YR 2021
UL http://bmjopengastro.bmj.com//content/8/1/e000501.abstract
AB 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.Data are available in a public, open access repository. All data relevant to the study are included in the article or uploaded as online supplemental information. All data have been included in the manuscript.