51. OWE-31 Management of pancreatic fluid collections within the northern region remote care pancreatitis service
- Author
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Jennifer Logue, John S. Leeds, Jeremy French, Manu Nayar, Richard Charnley, Kofi Oppong, Noor Bekkali, and David M. Bourne
- Subjects
education.field_of_study ,medicine.medical_specialty ,Percutaneous ,business.industry ,General surgery ,Population ,medicine.disease ,Intensive care unit ,Pulmonary embolism ,law.invention ,Parenteral nutrition ,law ,medicine ,Etiology ,Acute pancreatitis ,Pancreatitis ,education ,business - Abstract
Introduction Severe acute pancreatitis is a condition with high mortality with 40% of patients requiring intervention. NCEPOD recommends that this is best managed in a multidisciplinary team with access to specialist regional services as and when required. We report our experience of the management of pancreatic fluid collections (PFC) within the region’s first remote care pancreatitis network. Methods Data on patients with severe pancreatitis who were transferred to the service between June 2015 - July 2017 were analysed. The network was formally established in 2015 and serves a population of 3.5 million & 17 referring hospitals in the Northern region. All patients were discussed in the multidisciplinary meeting and only patients requiring specialist input were transferred. Baseline characteristics, aetiology, nutritional support, antibiotic treatment, intensive care unit (ITU) stay, interventions, complications, mortality and follow up of atleast one year were reported. Results 285 patients were referred during this period. 83/285 (29%; 46 male) were transferred with a mean age 56 years [range 18–85]. The commonest aetiology was gall stones(45%) & alcohol(31%). The main reason for transfer(91%) was drainage of peripancreatic collections. Patients were referred after a mean of 13.7 [1–188] days from admission locally; 26% were admitted directly to ITU. Patients were transferred 4.5 [0–16] days post-MDT discussion. Fifty-five (66%) received antibiotics; however only 17 (20%) had appropriate antibiotics based on positive blood cultures. Appropriate feeding was 98%; 70 (84%) patients were enterically fed and 12 received parenteral nutrition (PN). One patient had inappropriate PN. 21% patients had intervention prior to transfer. On transfer, 15/83(18%) did not require intervention as there was spontaneous resolution of the collections. In the remaining patients the interventions included: endoscopic drainage only = 48%, percutaneous only = 29%, endoscopic + percutaneous = 12% & others = 5%. 35%(29/83) had multiorgan failure. 31/83 (37%) had complications following intervention. These were: sepsis = 35%, bleeding = 39%, thromboembolic events = 16% & others = 10%. Twelve (14%) patients died, 10 had MOF and 2 had pulmonary embolism, 11/12 were in ITU. Mean follow up was 18.2 months (range = 14 – 35). Conclusions Majority of patients (82%) required intervention for treatment of PFCs. Endoscopic drainage was the commonest route of drainage. Inappropriate antibiotic use remains a concern however nutritional support was adequate in majority of the patients. This is the first reported data from the U.K. regarding a remote care network & the results highlight the role of regional multidisciplinary network in the management of patients with acute severe pancreatitis.
- Published
- 2019