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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...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
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.
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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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