Study of the early management of acute pancreatitis

Acute pancreatitis (AP) is a common acute surgical presentation with evidence-based guidelines for early management. The aim of this study was to assess the compliance to the published guidelines in patients presenting with AP in Western Sydney.

A retrospective case note audit was conducted for all patients with a confirmed diagnosis of AP from 2008 to 2011 in Western Sydney.

There were 932 patients. The mortality was low for mild (0.7%) and severe (1.2%) AP. There was an under-utilization of ultrasound (U/S) with 239 (25.6%) patients not having a U/S. There was an over-utilization of early (within 72 h) computed tomography scanning for diagnosis (31.1%), assessment of severity (16.1%) and assessment for the presence of complications (7.3%). Inappropriate prophylactic antibiotic usage occurred in 15.3% patients. Of 373 cases of gallstone pancreatitis, only 231 (69.1%) had a cholecystectomy within 4 weeks of presentation. There was an under-utilization of early endoscopic retrograde cholangiopancreatography for associated cholangitis (12.5%). Only 16 (18.8%) patients with severe pancreatitis received enteric feeding. In patients with pancreatic necrosis, 50% had invasive intervention delayed beyond 4 weeks and 69% had minimally invasive procedures performed prior to necrosectomy. Patients having a minimally invasive procedure initially showed an improvement in mortality compared with those who had primary necrosectomy (0 versus 40%, P = 0.025).

Although morbidity and mortality were acceptable, there was a failure to comply with evidence-based guidelines for the early management of pancreatitis. The results support for the development and auditing of protocols for the early assessment and treatment of AP in all hospitals.