Discharge protocol in acute pancreatitis: an international survey and cohort analysis
Authors: Nagy Rita , Ocskay Klementina , Sipos Zoltán , Szentesi Andrea , Vincze Áron , Czakó László , Izbéki Ferenc , Shirinskaya Natalia V. , Poluektov Vladimir L. , Zolotov Alexandr N. , Zhu Yin , Xia Liang , He Wenhua , Sutton Robert , Szatmary Peter , Mukherjee Rajarshi , Burridge Isobel Saffron , Wauchope Emma , Francisco Elsa , Aparicio David , Pinto Bruno , Gomes António , Nunes Vitor , Tantau Vasile Marcel , Sagau Emanuela Denisa , Tantau Alina Ioana , Suceveanu Andra Iulia , Tocia Cristina , Dumitru Andrei , Pando Elizabeth , Alberti Piero , Cirera Arturo , Molero Xavier , Lee Hong Sik , Jung Min Kyu , Kim Eui Joo , Lee Sanghyub , Rebollo María Lourdes Ruiz , Nistal Reyes Busta , Santervas Sandra Izquierdo , Lesko Dusan , Soltes Marek , Radonak Jozef , Zatorski Hubert , Małecka-Panas Ewa , Fabisiak Adam , Yaroslav M. Susak , Mykhailo V. Maksymenko , Olekcandr A. Tkachenko , Barauskas Giedrius , Simanaitis Vytautas , Ignatavicius Povilas , Jinga Mariana , Balaban Vasile-Daniel , Patoni Cristina , Gong Liang , Song Kai , Li Yunlong , Gonçalves T. Cúrdia , Freitas Marta , Macedo Vítor , Vornhuelz Marlies , Klauss Sarah , Beyer Georg , Koksal Aydin Seref , Tozlu Mukaddes , Eminler Ahmet Tarik , Monclús Nuria Torres , Comas Eva Pijoan , Oballe Juan Armando Rodriguez , Nawacki Łukasz , Głuszek Stanisław , Rama-Fernández Alberto , Galego Marco , de la Iglesia Daniel , Aykut Umut Emre , Duman Deniz Güney , Aslan Rahmi , Gherbon Adriana , Deng Lihui , Huang Wei , Xia Qing , Poropat Goran , Radovan Anja , Vranić Luka , Ricci Claudio , Ingaldi Carlo , Casadei Riccardo , Negoi Ionut , Ciubotaru Cezar , Iordache Florin Mihail , Constantinescu Gabriel , Sandru Vasile , Altintas Engin , Balci Hatice Rizaoglu , Constantino Júlio , Aveiro Débora , Pereira Jorge , Gunay Suleyman , Misirlioglu Sucan Seda , Dronov Oleksiy , Kovalska Inna , Bush Nikhil , Rana Surinder Singh , Chooklin Serge , Chuklin Serhii , Saizu Ionut Adrian , Gheorghe Cristian , Göltl Philipp , Hirth Michael , Mateescu Radu Bogdan , Papuc Geanina , Minkov Georgi Angelov , Enchev Emil Tihomirov , Mastrangelo Laura , Jovine Elio , Chen Weiwei , Zhu Quping , Gąsiorowska Anita , Fabisiak Natalia , Bezmarevic Mihailo , Litvin Andrey , Mottes Martina Cattani , Choi Eun Kwang , Bánovčin Peter , Nosáková Lenka , Kovacheva-Slavova Mila Dimitrova , Kchaou Ali , Tlili Ahmed , Marino Marco V. , Kusnierz Katarzyna , Mickevicius Artautas , Hollenbach Marcus , Molcan Pavol , Ioannidis Orestis , Tokarev Mark Valerievich , Ince Ali Tüzün , Semenenko Ivan Albertovich , Galeev Shamil , Ramírez-Maldonado Elena , Sallinen Ville , Pencik Petr , Bajor Judit , Sarlós Patricia , Hágendorn Roland , Gódi Szilárd , Szabó Imre , Czimmer József , Pár Gabriella , Illés Anita , Faluhelyi Nándor , Kanizsai Péter , Nagy Tamás , Mikó Alexandra , Németh Balázs , Hamvas József , Bod Barnabás , Varga Márta , Török Imola , Novák János , Patai Árpád , Sümegi János , Góg Csaba , Papp Mária , Erőss Bálint , Váncsa Szilárd , Teutsch Brigitta , Márta Katalin , Hegyi Péter Jenő , Tornai Tamás , Lázár Balázs , Hussein Tamás , Tarján Dorottya , Lipp Mónika , Kovács Beáta , Urbán Orsolya , Fürst Emese , Tari Edina , Kocsis Ibolya , Maurovich-Horvát Pál , Tihanyi Balázs , Eperjesi Orsolya , Kormos Zita , Deák Pál Ákos , Párniczky Andrea , Hegyi Péter 
Published: December 2023

There are several overlapping clinical practice guidelines in acute pancreatitis (AP), however, none of them contains suggestions on patient discharge. The Hungarian Pancreatic Study Group (HPSG) has recently developed a laboratory data and symptom-based discharge protocol which needs to be validated. (1) A survey was conducted involving all members of the International Association of Pancreatology (IAP) to understand the characteristics of international discharge protocols. (2) We investigated the safety and effectiveness of the HPSG-discharge protocol. According to our international survey, 87.5% (49/56) of the centres had no discharge protocol. Patients discharged based on protocols have a significantly shorter median length of hospitalization (LOH) (7 (5;10) days vs. 8 (5;12) days) p < 0.001), and a lower rate of readmission due to recurrent AP episodes (p = 0.005). There was no difference in median discharge CRP level among the international cohorts (p = 0.586). HPSG-protocol resulted in the shortest LOH (6 (5;9) days) and highest median CRP (35.40 (13.78; 68.40) mg/l). Safety was confirmed by the low rate of readmittance (n = 35; 5%). Discharge protocol is necessary in AP. The discharge protocol used in this study is the first clinically proven protocol. Developing and testifying further protocols are needed to better standardize patients’ care.