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Novel multidisciplinary hub-and-spoke tertiary service for the management of severe acute pancreatitis
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 n...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BMJ Publishing Group
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8016076/ https://www.ncbi.nlm.nih.gov/pubmed/33789915 http://dx.doi.org/10.1136/bmjgast-2020-000501 |
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author | Nayar, Manu K Bekkali, Noor L H Bourne, David Young, Sophie Leeds, John S Oppong, Kofi W Logue, Jennifer L Sen, Gourab French, Jeremy J Scott, John Cressey, David Pandanaboyana, Sanjay Charnley, Richard M |
author_facet | Nayar, Manu K Bekkali, Noor L H Bourne, David Young, Sophie Leeds, John S Oppong, Kofi W Logue, Jennifer L Sen, Gourab French, Jeremy J Scott, John Cressey, David Pandanaboyana, Sanjay Charnley, Richard M |
author_sort | Nayar, Manu K |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-8016076 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-80160762021-04-21 Novel multidisciplinary hub-and-spoke tertiary service for the management of severe acute pancreatitis Nayar, Manu K Bekkali, Noor L H Bourne, David Young, Sophie Leeds, John S Oppong, Kofi W Logue, Jennifer L Sen, Gourab French, Jeremy J Scott, John Cressey, David Pandanaboyana, Sanjay Charnley, Richard M BMJ Open Gastroenterol Pancreatitis 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. BMJ Publishing Group 2021-03-31 /pmc/articles/PMC8016076/ /pubmed/33789915 http://dx.doi.org/10.1136/bmjgast-2020-000501 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. |
spellingShingle | Pancreatitis Nayar, Manu K Bekkali, Noor L H Bourne, David Young, Sophie Leeds, John S Oppong, Kofi W Logue, Jennifer L Sen, Gourab French, Jeremy J Scott, John Cressey, David Pandanaboyana, Sanjay Charnley, Richard M Novel multidisciplinary hub-and-spoke tertiary service for the management of severe acute pancreatitis |
title | Novel multidisciplinary hub-and-spoke tertiary service for the management of severe acute pancreatitis |
title_full | Novel multidisciplinary hub-and-spoke tertiary service for the management of severe acute pancreatitis |
title_fullStr | Novel multidisciplinary hub-and-spoke tertiary service for the management of severe acute pancreatitis |
title_full_unstemmed | Novel multidisciplinary hub-and-spoke tertiary service for the management of severe acute pancreatitis |
title_short | Novel multidisciplinary hub-and-spoke tertiary service for the management of severe acute pancreatitis |
title_sort | novel multidisciplinary hub-and-spoke tertiary service for the management of severe acute pancreatitis |
topic | Pancreatitis |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8016076/ https://www.ncbi.nlm.nih.gov/pubmed/33789915 http://dx.doi.org/10.1136/bmjgast-2020-000501 |
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