North East of England regional severe acute pancreatitis remote care (SAP-RC) service

DM Bourne, JJ French & Acute Pancreatitis Team (JS Leeds, RM Charnley, K Oppong, M Nayar, J Logue, J Scott, S Saikia, S Young & S McMullen)

Background
Severe acute pancreatitis, as defined by the revised Atlanta classification,1 is caused by an acute inflammatory process affecting the pancreas gland.2 A recent review of acute pancreatitis1 advocated regional networks to aid management.  In North East of England, a formal network for has been in place since 2015. 

Aim
To evaluate North East of England regional severe acute pancreatitis remote care service.  

Methods
Patients referred were identified using a prospectively maintained database. All referrals from August 2015 – August 2017 were included. Data analysed included referrals, length of stay (LOS), antibiotic use, ICCU bed days, level of organ support, timing of transfer, interventions (operative, endoscopic, radiological), nutritional support and overall patient outcomes. 

Results
264 total referrals (57% male, mean age 57 years) with 24% (n=64) transferred to the tertiary centre, median base LOS of 21 days and median tertiary centre LOS of 28 days. Mortality at base hospital was 6% (n=17) and mortality at tertiary centre was 11% (n=7), overall mortality was 9% (n=24). Of transfers, 84% (n=54) had interventions, 20% (n=11) of interventions involved more than one modality. 55% (n=146) were receiving antibiotics on referral despite only 21% (n=146) of patients having had a positive culture. 44% (n=115) had base ICCU admission with median 9 day admission, with median maximum organ support of 2 (n=115) organs. 41% (n=26) of patients transferred to the tertiary centre were admitted to ICCU with median 14 day admission, with median maximum organ support of 3 (n=26) organs. 40% (n=105) of patients’ nutritional intake was managed with oral diet alone, 42% (n=111) received enteral feeding during admission, with NJ the most common route, used in 56% (n=62). Parenteral nutrition was used in 19% (n=50) during admission.

Conclusions
A formal regional network for severe acute pancreatitis can provide a high standard of care with good clinical outcomes, reflected by low mortality figures compared to international guidelines.