SP8.4 National variation in the management of pancreatitis and the effect on patient outcome

Abstract

Abstract Aim Pancreatitis is one of the most common general surgical presentations, but there is variation in how patients are managed. Our aim was to assess the degree of variation across the United Kingdom (UK) and how it affects patient outcomes. Method A multicentre, observational cohort study was carried out across the UK between March-April 2021. Admission variables including whether the unit was a district general or specialist unit were recorded. Imaging and operative details were collected with 30-day outcomes. Results Data from 113 hospitals were recorded, including 2580 patients. 24(21%) of these hospitals were specialist units. Imaging rates varied between sites, with ultrasound performed within 24 hours of admission on between 14 and 100% of patients and CT between 22 and 100% of patients. Between 0% and 100% of patients received a laparoscopic cholecystectomy within 30 days. Median length of stay was 5 days, but increased to 6 days in low volume centres (p=0.01). Variation in access to ultrasound and to surgery were related to hospital volume, but not whether they were a tertiary unit. Mortality and readmission rates were not correlated to hospital volume but unplanned readmission was higher in non-specialist centres (18.1%v14.4%, p=0.024). Conclusions There is significant inequity in accessing best practise pancreatitis care in the UK, based on admitting hospital. Case volume at a hospital was more significantly associated with access to imaging and surgery, than being a specialist centre, however specialist centres achieved lower rates of unplanned readmission.