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Delayed referral increases the need for surgery and intervention in patients with acute pancreatitis
Gaurav Muktesh1, Jayanta Samanta1, Anupam Kumar Singh1
1Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Early referral of acute pancreatitis (AP) patients to specialized centers improves outcomes. Delayed treatment beyond seven days increases complication risks but does not affect mortality.
Area of Science:
- Gastroenterology
- Surgical Gastroenterology
- Critical Care Medicine
Background:
- Acute pancreatitis (AP) is a significant cause of hospital admission.
- Many AP patients are initially managed at non-specialized facilities before transfer.
- Tertiary care centers play a crucial role in managing complex AP cases.
Purpose of the Study:
- To evaluate the outcomes of acute pancreatitis patients transferred to a tertiary care center.
- To compare outcomes between early (<7 days) and late (>7 days) referrals.
- To identify factors influencing patient outcomes in referred AP cases.
Main Methods:
- Retrospective analysis of 838 acute pancreatitis patients admitted between April 2013 and September 2019.
- Categorization of patients into early (<7 days) and late (>7 days) referral groups based on symptom onset.
- Comparison of complication rates, interventions, and mortality between the two groups.
Main Results:
- A significant proportion (77.6%) of AP patients were referred from other facilities.
- Late referrals (>7 days) showed significantly higher rates of organ failure (including lung and kidney injury), infected necrosis, and need for drainage or surgery.
- Despite increased complications, mortality rates were similar between early and late referral groups.
Conclusions:
- Early referral (within 7 days) of acute pancreatitis patients to specialized tertiary care centers is associated with better clinical outcomes.
- Timely intervention in AP management is critical for reducing severe complications.
- While early referral mitigates complications, further research may explore strategies to improve outcomes in late-referral patients.
Background:
The aim was to study the outcomes of acute pancreatitis (AP) patients who were referred from other facilities to a tertiary care centre.
Methods:
Patients with AP were who were referred from other hospitals to a tertiary care centre between April 2013 and September 2019 were studied and their outcomes were analysed. Comparison was made between patients referred early (≤7 days) versus those referred late (>7 days).
Results:
Of the 838 patients seen by us, 650 patients (77.6%) were referred from other centres. Median (interquartile range) onset to admission interval was 5 (4-7) days for those who were referred ≤7 days and was 16 (11-30) for those who were referred >7 days. Patients referred beyond 7 days of pain onset had higher rates of development of organ failure (P = 0.007), including acute lung injury (P = 0.008) and acute kidney injury (P = 0.026), infected necrosis (P < 0.0001), requirement of endoscopic/percutaneous drainage (P < 0.001) and need for surgery (P < 0.02) compared to patients who were referred ≤7 days of pain onset. Mortality was however similar in the two groups.
Conclusion:
Patients with AP referred to a specialized centre with AP early (≤7 days) have better outcomes than those referred late (>7 days) from other facilities.
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