WTP7.4 Is there a role for ambulatory management of acute pancreatitis in selected cases?

Abstract

Abstract Aim Pancreatitis is a common general surgical condition that presents with variable severity. The usual management involves a hospital admission for observation, lasting a median of five days. However, there may be a role for ambulatory management. We aimed to determine which patients presenting with acute pancreatitis may be suitably managed in the community. Method This prospective, multicentre cohort study at 113 UK sites included adult patients diagnosed with pancreatitis. Potential for ambulatory management was defined as the presence of mild pancreatitis, tolerating oral fluids, and oral analgesic requirement only. Multilevel logistic regression models determined relationships, accounting for the clustering of patients within hospitals. Results Of 2580 patients included, only 13 (0.5%) patients were managed without admission and 150 (6.1%) patients were admitted a single night only. Overall 1836 (71%) of patients had mild pancreatitis, of which 928 (50.5%) were potentially suitable for ambulatory care. After accounting for median CRP peak at 48 hours, a CRP of <150 at 48 hours was associated with a lower risk of all complications (OR 0.35, 95% CI 0.30-0.42; P<0.001) and CT-confirmed collection and/or necrosis (0.18, 0.15-0.22; P<0.001). Patients were also twice as likely to be suitable for ambulation (OR 2.07, 1.75-2.44; P<0.001). Conclusion Just over a third of patients with pancreatitis could potentially be managed ambulatory. CRP at 48 hours is a strong predictor of pancreatitis-associated complications and may help direct further follow up.