Related Experiment Video
Updated: Sep 23, 2025
Robotic-assisted Lateral Pancreaticojejunostomy for Chronic Pancreatitis
Published on: September 5, 2025
Management of Complicated Acute Pancreatitis: The Role of Hub-and-Spoke Model
Khalid Munir Bhatti1, Shafiq Rehman1, Salman Ejaz Ahmed1
1Department of Surgery, North Cumbria Integrated Care, Carlisle, UK.
Insights
Complicated acute pancreatitis (CAP) patients face higher risks of intensive therapy unit admission, prolonged hospital stays, and mortality. Developing new strategies to prevent progression and improve treatment for CAP is crucial for better patient outcomes.
Area of Science:
- Gastroenterology
- Surgical Outcomes
- Public Health
Background:
- Acute pancreatitis is a significant medical condition with varying severity.
- Complicated acute pancreatitis (CAP) presents local and/or systemic complications.
- The Revised Atlanta classification is used to define and categorize CAP severity.
Purpose of the Study:
- To evaluate the outcomes of patients with moderate to severe complicated acute pancreatitis (CAP) managed via a hub-and-spoke model.
- To identify primary and secondary outcomes associated with CAP management.
- To analyze morbidity and mortality rates in CAP patients.
Main Methods:
- Observational study with retrospective analysis of 496 episodes in 405 patients.
- Data collected from January 2014 to December 2018.
- Analysis included demographic features, clinical outcomes, and adherence to the Revised Atlanta classification.
Main Results:
- The frequency of CAP was 21.7%.
- Patients with moderately severe AP (MSAP) and severe AP (SAP) showed significantly higher rates of complications, intensive therapy unit (ITU) admission, prolonged hospital stay, and mortality.
- In-hospital mortality was 10.2%, and overall mortality was 14.8%.
Conclusions:
- The progression from mild acute pancreatitis to MSAP and SAP remains a concern.
- CAP patients exhibit increased risks for ITU admission, extended hospital stays, and higher mortality rates.
- Novel strategies are needed to prevent AP progression and innovative treatments to reduce mortality in complicated cases.
Objective:
To determine the primary and secondary outcomes of patients with complicated acute pancreatitis (CAP) of moderate to severe intensity managed by using the hub-and-spoke model.
Study Design:
An observational study.
Place And Duration Of Study:
Department of Surgery, North Cumbria Integrated Care, Carlisle, UK, from January 2014 to December 2018.
Methodology:
Retrospective analysis of 496 episodes of acute pancreatitis managed in 405 patients was done. Data for demographic features and clinical outcomes were analysed. In patients with recurrent admissions, only index admission was considered for analysis. Complicated acute pancreatitis was defined by using the revised Atlanta classification and included all the acute pancreatitis patients with local and or systemic complications. Results: The frequency of CAP was 21.7% (88/405). The mean patients' age was 62.11 ± 17.90 years. The intensive therapy unit (ITU) admission rate was 33% (n = 29), whereas the overall intervention rate was 43.2% (n = 38). The in-hospital mortality rate was 10.2% (n = 9), and the overall mortality rate was 14.8% (n = 13). A comparative analysis of clinical outcomes according to the revised Atlanta classification showed that the rate of complications, need for ITU admission, duration of hospital stay, in-hospital mortality and overall mortality were significantly higher in patients with moderately severe AP (MSAP) and severe AP (SAP).
Conclusion:
The rate of progression from mild AP to MSAP and SAP remains high. Patients with CAP are at higher risk of ITU admission, prolonged hospital stay, in-hospital mortality and overall mortality. To improve clinical outcomes, the progression of AP to severer forms should be prevented by developing newer strategies, and in cases where complications have already developed, the mortality rate needs to be improved by developing innovative treatment modalities.
Key Words:
Acute pancreatitis, Complicated acute pancreatitis, Revised Atlanta classification, Morbidity, Mortality, Survival analysis, Hub and spoke model.
Related Concept Videos
01:29Chronic Pancreatitis II: Collaborative Care
Assessment:
01:30Acute Pancreatitis II: Clinical Manifestations and Management
01:27Acute Pancreatitis I: Introduction
Acute pancreatitis is characterized by rapid inflammation of the pancreas, often caused by factors like gallstone blockage or excessive alcohol consumption. Chronic pancreatitis, on the other hand, is a slow, progressive inflammation that may result from long-term alcohol abuse, obstructions in the pancreatic duct, or genetic factors.
The causes of acute pancreatitis include:
01:26Endoscopic Procedures V: ERCP
Patient...
01:24Chronic Pancreatitis I: Introduction
Pancreatitis is the inflammation of the pancreas, which occurs when the immune system becomes active and causes swelling, pain, and disruptions in organ function. Pancreatitis can manifest as either an acute or chronic condition.
Acute pancreatitis arises suddenly and lasts for a brief duration, while chronic pancreatitis is a long-term affliction...