143 How Well Are We Managing Acute Pancreatitis?

Aim

To evaluate our practice in comparison with gold standards on the management of acute pancreatitis.

Method

This retrospective audit evaluated the management of patients with acute pancreatitis admitted to our hospital between 01/04/22 and 30/06/22. The gold standards were guidelines published by the World Society of Emergency Surgery (2019) and British Medical Journal (2018). Data collection focused on prognostic scoring, IV fluid resuscitation, nutrition, monitoring of patients, invasive intervention, and performance of cholecystectomy. Data sources included paper notes, imaging and prescribing software.

Results

44 patients presented with acute pancreatitis. A prognostic score was calculated in only 4 patients (9.1%). 40 patients (90.1%) received isotonic IV fluids. However, fluid input and output was poorly documented in 17 patients (38.6%). 14 patients (31.8%) received nutritional support; oral Fortisip supplements in the majority (11 patients, 25%).

Regarding outcomes, 5 patients (13.6%) developed single or multi-organ dysfunction (respiratory and/or renal failure): 2 patients (4.5%) required admission to the High Dependency Unit. 2 patients (4.5%) died.

Regarding intervention, appropriately, no patients underwent endoscopic or percutaneous drainage of pancreatic collections. Where gallstones were the underlying aetiology (12 patients, 27.3%), 10 patients (22.8%) underwent laparoscopic cholecystectomy during, or within 2 weeks of, the index admission.

Conclusions

Our compliance with gold standards was variable, and this could negatively impact patient care. Lack of prognostic scoring and fluid balance documentation may undermine ability to recognise deteriorating patients with severe pancreatitis requiring escalation of care. Departmental teaching for surgical doctors is the proposed intervention.