Quality Gaps in Management of Acute Pancreatitis

Abstract

Objectives: Acute pancreatitis (AP) is a leading cause of inpatient care among gastrointestinal conditions. Our study compares the management of AP and adherence to guidelines among teaching medicine, nonteaching medicine, and surgical services within the same center.Methods: We performed a retrospective chart review of AP patients admitted to our center between January 2016 and January 2017 and analyzed the clinical and epidemiological data.Results: Of 115 patients, 65% were admitted to medicine (IM), and 35% were admitted to surgery. Mean age was 53.9 (standard deviation [SD], 15) years, and 52% were males; 38.6% (n = 29) of IM patients were prescribed lactated Ringer's solution for fluid resuscitation (mean rate of 153 [SD, 44.98] mL/h on teaching and 113 [SD, 43.56] mL/h on the nonteaching service). Antibiotics were prescribed to 22.6% (n = 17) of IM patients. On the surgical service, 77.5% of patients were prescribed lactated Ringer's solution for fluid resuscitation (mean rate of 108.25 [SD, 1.19] mL/h); 52.5% of patients received antibiotics.Conclusions: Adherence to guidelines for management of AP is inadequate, and nonuniformity exists across different services within the same institution. There is a need for quality improvement initiatives.

coMpliAnce with evideNce-based cliniCal guidelines in the managemenT of acute biliaRy pancreAtitis): The MANCTRA-1 international audit

“…Previous studies compared the management of ABP and adherence to guidelines among academic surgical services, HPB services, academic medicine, and non-academic medicine in the same institution and showed that adherence to guidelines for the management of AP is inadequate, and non-uniformity exists across different services within the same institution [57]. The study by Aly et al [58] showed differences between the reported practice of HPB surgeons and non-specialists in the management of ABP, suggesting that the specialists may be more aware of the guidelines and the evidence supporting them.…”

Recurrent Acute-on-Chronic Pancreatitis in a Chronic Alcoholic With Pancreatic Divisum: A Complex Case

“…Chronic pancreatitis presents with abdominal pain, nausea, and vomiting. However, it can also present without abdominal pain but with steatorrhea, and weight loss [4].…”

A Rare Case of Paxlovid-Induced Pancreatitis

“…Other causes include alcohol, hypertriglyceridemia, autoimmune disease, or secondary to pancreatic manipulation, such as endoscopic retrograde cholangiopancreatography (ERCP). The annual incidence of AP in the United States is 4.9-35 per 100,000 population and accounts for roughly 200,000 hospital admissions per year: drug-induced pancreatitis accounts for only <5% of the cases [1]. Microorganisms, including viruses, have been reported to also have a role.…”