S3074 Disparities in Management of Acute Pancreatitis Between Specialties at a Metropolitan Medical Center

Abstract

INTRODUCTION: Acute pancreatitis (AP) is one of the leading causes of the gastrointestinal conditions warranting admission in the United States. Multiple clinical guidelines exist for AP, however institutional practices vary in adherence to these. The goal of our study was to compare management of AP and adherence to guidelines, more specifically early enteral feeding and choice of fluids, amongst the medical service compared to other services within the same metropolitan center. METHODS: We performed a retrospective chart review of patients admitted with diagnosis of AP between 2016 and 2018 at an urban metropolitan medical center. We excluded patients who were admitted for palliation, received surgery or endoscopy, and those who left against medical advice within 12 hours. Data collected included demographics, admitting team between the medical and surgical service, time to enteral feeding, initial crystalloids and rate, BISAP score, length of stay (LOS) and mortality. RESULTS: 101 charts were reviewed, 98 of which met the inclusion criteria. Of those admitted to medicine service, 68% received LR at an average rate of 206.2 mL/hr. Of the patient admitted to the surgical service, 78% received LR at an average fluid rate of 150.3 mL/hr (P < 0.05). Only 3% of patients did not have adequate studies to assess for BISAP score. The average BISAP score of those admitted to medicine and surgical service was 0.73 and 1.10, respectively (P = 0.09). Average time to enteral feeding was 25.9 hours and 56.3 hours for medicine and surgical service, respectively (P < 0.05). LOS on the medicine service and surgical services was 4.4 days and 6.2 days, respectively (P = 0.02). CONCLUSION: Our study demonstrates the variability in management of AP in an urban metropolitan center. Despite numerous national guidelines on best practice in AP, it is limited in clinical practice due to multiple factors, including; time to diagnosis, severity of disease, and evaluation for procedures. Despite similar severity of disease assessed by the BISAP score, patients received different management between the services. We observed longer time to enteral nutrition and longer length of stay, despite excluding those who required endoscopic and surgical intervention. This is an area for improvement to help mitigate the significant burden of AP on our health care system.Table 1.: Table showing patient demographics, BISAP score, and Fluid ResuscitationFigure 1.: Graph depicting time to advance diet between the medical and surgical service.Figure 2.: Graph depicting average LOS for medical and surgical service.