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

Abstract

Discharge protocol; Acute pancreatitis

Protocol d'alta; Pancreatitis aguda

Protocolo de alta; Pancreatitis aguda

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.

The study was supported by a project grant (TKP2021-EGA-23) of the Ministry of Innovation and Technology of Hungary to PH, by an NKFIH OTKA grant (K131996) to PH, by the János Bolyai Research Scholarship of the Hungarian Academy of Sciences (to AM), by the Project Grants (KA–2019–14, FK131864 to AM) and by the ÚNKP–22–5 New National Excellence Program of the Ministry for Innovation and Technology from the source of the National Research, Development and Innovation Fund (to AM). The project has received funding from the EU’s Horizon 2020 research and innovation program under grant agreement No. 739593. (to BCN). BCN has received funding from János Bolyai Research Grant (BO/00648/21/5) and the New National Excellence Program (UNKP-22-5-SZTE-585) and it was supported by the ÚNKP-22-4-II New national Excellence Program of the Ministry for Culture and Innovation from the Source of the National Research, Development and Innovation Fund (to KM).