Quality of treatment for acute pancreatitis at UNN Tromsø 2019-2023: Adherence to clinical guidelines and identification of areas for improvement

Abstract

Background

Acute pancreatitis is a gastrointestinal condition characterised by severe epigastric pain, in some cases causing pancreatic necrosis and/or multiorgan failure. Newer guidelines, such as IAP/APA, intend to aid clinicians in the management of the disease by formulating evidence-based, easy-to-follow recommendations. This study aimed to investigate the management of patients with acute pancreatitis at the gastrointestinal surgery department at the University Hospital of Northern Norway and their adherence to 12 selected recommendations.

Materials and method

This was an observational study analysing data of 504 patients admitted for acute pancreatitis between 2019 and 2023.

Results

Overall, 501 (99%) patients had their vitals evaluated at admission, and 426 (85%) were found to have at least two criteria for diagnosis of acute pancreatitis. Patients were given a median amount of 2L the first 24 hours, and 371 (74%) patients received intravenous fluid resuscitation of only Ringer’s lactate. 255 (78%) patients managed early oral nutrition, and early CT was avoided in 119 (57%). 27 (69%) patients with severe acute pancreatitis were transferred to an intensive care unit. No significant difference in length of hospital stay or mortality was found between the ICU and non-ICU patients (p = 0,626). 83 (17%) patients were later re-admitted due to complications and 8 (2%) died during index admission. There was a significant difference in guideline adherence from 2019 to 2023 in patients with mild biliary acute pancreatitis who had an early cholecystectomy (p = 0,001), documented goal of fluid therapy (p = <0,001) and antibiotic treatment (p = 0,014). The adherence rate across all recommendations increased from 71% to 81% in 2023.

Conclusion

A few areas for improvement were identified through this study, the data pointing towards possible overuse of radiology and antibiotics, but the findings indicate a high adherence to guidelines at the department of gastrointestinal surgery.