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Adherence to Guidelines Influenced the Mortality, Hospital Stay, and Health Care System Costs in Patients With Acute
Claudio Ricci, Carlo Ingaldi1, Laura Alberici1
1From the Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna.
Insights
Adherence to acute pancreatitis guidelines was low at 0.6%, but compliance significantly reduced mortality, hospital stay, and healthcare costs. Improving guideline adherence is crucial for better patient outcomes.
Area of Science:
- Gastroenterology and Hepatology
- Clinical Medicine
- Health Services Research
Background:
- Acute pancreatitis (AP) management guidelines exist to optimize patient care.
- Assessing adherence to these guidelines is essential for evaluating clinical practice and patient outcomes.
Purpose of the Study:
- To evaluate the compliance rate with acute pancreatitis guidelines.
- To determine the impact of guideline adherence on mortality, hospital stay, and costs.
Main Methods:
- A retrospective study of 1904 patients with acute pancreatitis, divided into two groups based on diagnosis date (before and after 2013).
- Analysis of compliance rates for various guideline components, including fluid resuscitation, antibiotics, feeding, imaging, and surgical interventions.
- Statistical analysis to correlate compliance with mortality, hospital stay, and costs.
Main Results:
- Overall compliance with AP guidelines was low (0.6%).
- Compliance rates showed improvement in specific areas like fluid resuscitation and ERCP use.
- Compliance with severity assessment, nutrition, and early surgery recommendations was associated with reduced mortality.
- Adherence to antibiotic therapy, nutrition, ERCP, and early surgery protocols decreased hospital stay.
- Compliance with nutrition, ERCP, and surgery protocols led to reduced healthcare costs.
Conclusions:
- Adherence to acute pancreatitis guidelines remains low.
- Improved compliance with AP guidelines has the potential to significantly decrease mortality, reduce hospital length of stay, and lower healthcare expenditures.
Objectives:
The primary end point was the compliance rate with guidelines. The secondaries were mortality, hospital stay, and costs.
Methods:
This study included 1904 patients with acute pancreatitis (AP): group A, diagnosed before 2013, and group B, after 2013.
Results:
The compliance rate was 0.6%. The compliance rates increased for fluid resuscitation (3.3% vs 13.7%, P < 0.001), for antibiotics use (21.9% vs 28.1%, P = 0.002), for oral feeding (55.0% vs 49.7%, P = 0.007), and for correct use of endoscopic retrograde cholangiopancreatography (ERCP) (83% vs 91.9%, P < 0.001). Compliance to severity assessment with computed tomography (odds ratio [OR], 0.4; P = 0.029), parenteral nutrition recommendations (OR, 0.3; P = 0.009), and early surgery (OR, 0.3; P = 0.010) reduced the mortality. Compliance to antibiotic therapy (OR, 0.6; P < 0.001), correct use of parenteral nutrition (OR, 0.3; P < 0.001), correct use of ERCP (OR, 0.5; P < 0.001), and early surgery (OR, 0.3; P = 0.010) reduced hospital stay. The compliance reduced the costs for parenteral nutrition (P < 0.001), correct use of ERCP (P = 0.011), and surgery (P = 0.010).
Conclusions:
The adherence to guidelines for AP was low. Compliance could reduce mortality, prolonged hospital stay, and costs.
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