BJS Prize 4 PANC Study (Pancreatitis: A National Cohort Study)

Abstract

Abstract Aims Acute pancreatitis (AP) is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. This first UK, multicentre, prospective audit aims to assess variation in management of AP to guide resource planning and optimise treatment. Method All patients ≥18 years presenting with AP, as per the Atlanta criteria, from March-April 2021 were included and followed up for 30 days prospectively. Anonymised data was uploaded to a secure electronic database in line with local governance approvals. Results 113 hospitals contributed data on 2580 patients, with 1287 (49.8%) female and a mean age of 57 years. The aetiology of AP was gallstones in 50.6% (n=1306), alcohol in 17.5% (n=452) and idiopathic in 22.4% (n=579). 34.7% (n=893) received antibiotics within 48 hours of which 4.7% (n=121) had confirmed infection. CT was performed in 54.5% (n=1406), most commonly within 24 hours of admission (41%). MRCP was performed in 39.9% (n=1029); gallstones were diagnosed in 18.3% (48/262) who had not been seen on ultrasound. EUS was performed in 1.1% (n=29). 34.1% (n=441) of patients with gallstone disease underwent cholecystectomy by 30 days. Conclusion Management of AP in the UK deviates from national and international guidelines. Recommendations include improving antibiotic stewardship, further investigation to be performed in idiopathic cases of AP, consideration of further biliary imaging when looking for gallstones and improving appropriate timing of CT. Further work will look at guidance for diagnostic pathways and development of protocols for ambulatory management in mild AP.