Inpatient service improves outcomes in mild acute pancreatitis

Implementation of an inpatient pancreatitis service appears to result in better outcomes in patients with mild acute pancreatitis, suggests a study. Guideline-based educational interventions deliver benefits on the management of this condition by admitting teams even without pancreatitis consultation.

A group of researchers introduced an inpatient pancreatitis consultative service to provide guideline-based recommendations to acute pancreatitis inpatients (2008‒2018) and educate inpatient teams on best practices for acute pancreatitis management in this cohort study. The intervention was a decision support tool, reinforced at hospital-wide education forums.

The first phase of the study (part A; n=965) compared outcomes pre- (2008‒2010) to postservice (2012‒2018), excluding 2011, when the pancreatitis service was introduced. For the second phase (part B; n=720; 2012‒2018), the researchers divided patients into two groups based on if co-managed with the pancreatitis service and compared outcomes, including subgroup analysis based on severity.

In part A, inpatients with mild acute pancreatitis had significantly improved length of stay (111 vs 88.4 h; p=0.001), refeeding time (61.8 vs 47.4 h; p=0.002), and infections (10.0 percent vs 1.87 percent; p<0.001) after implementing the pancreatitis service. Multivariable analysis confirmed the shorter length of stay (odds ratio [OR], 0.83, 95 percent confidence interval [CI], 0.82‒0.84; p<0.001) and refeeding time (OR, 0.75, 95 percent CI, 0.74‒0.77; p<0.001).

In part B, however, refeeding time (44.2 vs 50.3 h; p=0.123) and infections (5.58 percent vs 4.70 percent; p=0.80) did not significantly differ in patients cared for with and without the service. Moreover, length of stay was longer in the service group (93.3 vs 81.2 h; p=0.05), with more gallstone acute pancreatitis patients showing greater length of stay and magnetic resonance cholangiopancreatography.

The pancreatitis service was extended to most patients with moderate/severe acute pancreatitis and nearly all intensive care unit during the postservice period.