Discharge protocol in acute pancreatitis: an international survey and cohort analysis

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.

Very early and early nutrition in children with pancreatitis—A randomised trial

“…The latest study conducted among adults with AP shows that patients discharged based on protocols have a significantly shorter median LOH (7 days [5;10] vs. 8 days [5;12]; p < 0.001], and a lower rate of readmission due to recurrent AP episodes (p = 0.005). 36 In our study, the protocol did not specify the criteria for discharge from the hospital and the time differed between centres based on their experience and internal arrangements.…”

Association between acute peripancreatic fluid collections and early readmission in acute pancreatitis: A propensity-matched analysis

“…The median cost of readmissions was also higher compared to index hospitalizations. In a recent international survey, Nagy et al [ 62 ] revealed the efficacy of the AP discharge protocol in significantly reducing median LOS and recurrent AP-related readmission rates. Our findings could enable pancreatologists to devise novel discharge protocols that include index admission APFC and assess their impact in future research.…”