P2127 - The Value of Educational Guidance of a Pancreatitis Consult Service Through Guideline-Based Management of Acute Pancreatitis

Tuesday, October 26, 2021

10:30 AM – 4:00 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Cinthana Kandasamy, MD

Beth Israel Deaconess Medical Center, Harvard Medical School
Boston, MA, United States

Cinthana Kandasamy, MD¹, Ishani Shah, MD¹, Awais Ahmed, MD¹, William Yakah, BS¹, Supisara Tintara, MD¹, Cristina Sorrento, MD¹, Steven D. Freedman, MD, PhD¹, Darshan J. Kothari, MD², Sunil G. Sheth, MD¹
¹Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; ²Duke University Medical Center, Durham, NC

Introduction: In 2011, we created an inpatient pancreatitis consultative service at our tertiary care center aimed to improve the management of patients with acute pancreatitis (AP). A key goal of the service was to provide education to medicine trainees and hospitalists on fundamentals of AP management in order to enable them to care for AP patients independently, especially mild AP. This intervention included clinical decision tools, educational seminars and point of care expertise by pancreatologists. We assessed the impact of this educational intervention on AP outcomes.

Methods: We performed a retrospective review of patients admitted with AP after the pancreas service was implemented (2012-2018), excluding patients who presented in 2011 (“wash-in period”). We compared outcomes of AP patients seen by medicine teams alone versus concurrently with the pancreatitis service. Primary outcomes were mean length of stay (LOS) and time to refeeding. Secondary outcomes were all-cause mortality, 30-day readmission, infectious complications, and advanced imaging. We performed a subgroup analysis focusing on severity of AP based on the revised Atlanta criteria.

Results: For mild AP, LOS was 81.2h in patients without and 93.3h in patients with a pancreatitis consult (p=0.05). The consult service saw a higher proportion (71.8%) of gallstone AP who had a longer LOS compared to non-gallstone AP (100h v. 83.2h, p=0.015). Refeeding time was similar in patients without and with a consult (44.2h v. 50.3h, p=0.123, Table 1). The majority of moderate-severe AP were seen by the pancreatitis service (77%), including nearly all ICU-admitted patients (96%). In the consult cohort, there was a significantly higher rate of ICU admission (16.1% v. 2.4%, p=0.04).

Discussion: There was no significant difference in refeeding time, infection, mortality, and readmission between mild AP patients cared for solely by a medicine team and along with the consult service. Mean LOS was slightly higher in the consult group, which may be due to the larger proportion of gallstone AP seen by the service. Similarity in outcomes demonstrates the valuable impact of education via algorithmic management guidelines. Simple interventions like goal-directed fluid resuscitation, pain and antiemetic control, and early feeding trials were easily followed by non-GI providers. Optimized allocation of subspeciality resources allowed the pancreatitis service to focus on more severe and complex cases of AP, like ICU patients.

Outcome Measures	No pancreatitis service consult (N=217)	Pancreatitis service consult (N=321)	P-value
Mean LOS in hours	81.2 (57.9)	93.3 (85.9)	0.050
Average number of hours to advancing nutrition	44.2 (28.6)	50.3 (34.0)	0.123
Number of patients getting CT	80 (36.9%)	137 (42.7%)	0.208
Number of patients getting MRCP	36 (16.6%)	77 (24.0%)	0.050
General infection complications	12 (5.58%)	15 (4.70%)	0.800
ICU admission	1 (0.46%)	4 (1.25%)	0.653
Inpatient mortality	1 (0.46%)	2 (0.62%)	1.000
30-day readmission	39 (18.4%)	59 (18.8%)	1.000

Table: Table 1. Outcomes of mild acute pancreatitis patients post service implementation: comparing cohorts with and without a pancreatitis consult

Disclosures:

Cinthana Kandasamy indicated no relevant financial relationships.

Ishani Shah indicated no relevant financial relationships.

Awais Ahmed indicated no relevant financial relationships.

William Yakah indicated no relevant financial relationships.

Supisara Tintara indicated no relevant financial relationships.

Cristina Sorrento indicated no relevant financial relationships.

Steven Freedman indicated no relevant financial relationships.

Darshan Kothari indicated no relevant financial relationships.

Sunil Sheth indicated no relevant financial relationships.

Cinthana Kandasamy, MD¹, Ishani Shah, MD¹, Awais Ahmed, MD¹, William Yakah, BS¹, Supisara Tintara, MD¹, Cristina Sorrento, MD¹, Steven D. Freedman, MD, PhD¹, Darshan J. Kothari, MD², Sunil G. Sheth, MD¹. P2127 - The Value of Educational Guidance of a Pancreatitis Consult Service Through Guideline-Based Management of Acute Pancreatitis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.