Discharge protocol in acute pancreatitis: an international survey and cohort analysis
Rita Nagy, Klementina Ocskay, Zoltán Sipos, Andrea Szentesi, Áron Vincze, László Czakó, Ferenc Izbéki, N. V. Shirinskaya, В. Л. Полуэктов, Alexandr N. Zolotov, Yin Zhu, Liang Xia, Wenhua He, Robert Sutton, Peter Szatmary, Rajarshi Mukherjee, Isobel Burridge, Emma Wauchope, Elsa Francisco, David Aparício, Bruno Pinto, António Gomes, Vítor Nunes, Vasile Marcel Tantau, Emanuela Denisa Sagau, Alina Tanțău, Andra‐Iulia Suceveanu, Cristina Tocia, Andrei Dumitru, Elizabeth Pando, Piero Alberti, Arturo Cirera, Xavier Molero, Hong Sik Lee, Min Kyu Jung, Eui Joo Kim, Sanghyub Lee, María Lourdes Ruiz Rebollo, Reyes Busta Nistal, Sandra Izquierdo Santervás, Dušan Leško, Marek Šoltés, J Radoňák, Hubert Zatorski, Ewa Małecka‐Panas, Adam Fabisiak, M. Susak Yaroslav, V. Maksymenko Mykhailo, A. Tkachenko Olekcandr, Giedrius Barauskas, Vytautas Simanaitis, Povilas Ignatavičius, Mariana Jinga, Daniel Vasile Balaban, Cristina Patoni, Liang Gong, Kai Song, Yunlong Li, Tiago Cúrdia Gonçalves, Marta Freitas, V.A.S. Macedo, Marlies Vornhuelz, Sarah Klauss, Georg Beyer, Aydın Şeref Köksal, Mukaddes Tozlu, Ahmet Tarık Eminler, N. Torres Monclús, Eva Pijoan Comas, J.A. Rodríguez Oballe, Łukasz Nawacki, Stanisław Głuszek, Alberto Rama‐Fernández, Marco Galego, Daniel de la Iglesia, Umut Emre Aykut, Deniz Duman, Rahmi Aslan, Adriana Gherbon, Lihui Deng, Wei Huang, Qing Xia, Goran Poropat, Anja Radovan, Luka Vranić, Claudio Ricci, Carlo Ingaldi, Riccardo Casadei, Ionuţ Negoi, Cezar Ciubotaru, Florin Iordache, Gabriel Constantinescu, Vasile Şandru, Engin Altıntaş, Hatice Rızaoğlu Balcı, Júlio Constantino, Débora Aveiro, Jorge Pereira, Süleyman Günay, Seda Misirlioglu Sucan
Abstract
There are several overlapping clinical practice guidelines in acute pancreatitis (AP), however, none of them contains suggestions on patient discharge. The Hungarian Pancreatic Study Group (HPSG) has recently developed a laboratory data and symptom-based discharge protocol which needs to be validated. (1) A survey was conducted involving all members of the International Association of Pancreatology (IAP) to understand the characteristics of international discharge protocols. (2) We investigated the safety and effectiveness of the HPSG-discharge protocol. According to our international survey, 87.5% (49/56) of the centres had no discharge protocol. Patients discharged based on protocols have a significantly shorter median length of hospitalization (LOH) (7 (5;10) days vs. 8 (5;12) days) p < 0.001), and a lower rate of readmission due to recurrent AP episodes (p = 0.005). There was no difference in median discharge CRP level among the international cohorts (p = 0.586). HPSG-protocol resulted in the shortest LOH (6 (5;9) days) and highest median CRP (35.40 (13.78; 68.40) mg/l). Safety was confirmed by the low rate of readmittance (n = 35; 5%). Discharge protocol is necessary in AP. The discharge protocol used in this study is the first clinically proven protocol. Developing and testifying further protocols are needed to better standardize patients' care.