Mild acute biliary pancreatitis : still a surgical disease. A post-hoc analysis of the MANCTRA-1 international study
Cioffi, Stefano Piero Bernardo (Università degli Studi di Roma "La Sapienza")
Spota, Andrea (Niguarda Hospital (Milan, Itàlia))
Virdis, Francesco (Niguarda Hospital (Milan, Itàlia))
Altomare, Michele (Università degli Studi di Roma "La Sapienza")
Mingoli, Andrea (Università degli Studi di Roma "La Sapienza")
Cimbanassi, Stefania (University of Milan)
Nava, Francesca Laura (University of Milan)
Nardi, Silvana (San Raffaele University)
Di Martino, Marcello (University of Piemonte Orientale)
Di Saverio, Salomone (Madonna del Soccorso Hospital (San Benedetto del Tronto, Itàlia))
Ielpo, Benedetto (Hospital del Mar (Barcelona, Catalunya))
Pata, Francesco (University of Calabria (Rende, Itàlia))
Pellino, Gianluca (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Sartelli, Massimo (Macerata Hospital. General and Emergency Surgery)
Damaskos, Dimitris (Royal Infirmary of Edinburgh. General and Emergency Surgery)
Coccolini, Federico (University Hospital of Pisa (Pisa, Itàlia))
Pisanu, Adolfo (University of Cagliari (Itàlia))
Catena, Fausto (Bufalini Hospital)
Podda, Mauro (University of Cagliari (Itàlia))
Universitat Autònoma de Barcelona

Data:	2025
Resum:	The current standard of care for mild acute biliary pancreatitis (MABP) involves early laparoscopic cholecystectomy (ELC) to reduce the risk of recurrence. The MANCTRA-1 project revealed a knowledge-to-action gap and higher recurrence rates in patients admitted to medical wards, attributable to fewer ELCs being performed. The project estimated a 35% to 70% probability of narrowing this gap by 2025. This study evaluates the safety of suboptimal ELC implementation and identifies risk factors for recurrent acute biliary pancreatitis (RAP) in patients not undergoing ELC after an MABP episode. We conducted a post-hoc analysis of the MANCTRA-1 registry, including MABP patients who did not undergo ELC during the index hospitalization, excluding those with related complications. The primary outcome was the 30-day hospital readmission rate due to RAP. We performed multivariable logistic regression to find risk factors associated with the primary outcome. Between January 2019 and December 2020, 1920, MABP patients from 150 centers were included in the study. The 30-day readmission rate due to RAP was 6%. Multivariable logistic regression found the admission to a medical ward (internal medicine or gastroenterology) (OR = 1. 95, p = 0. 001) and a positive COVID-19 test (OR = 3. 08, p = 0. 029) as independent risk factors for RAP. Our analysis offers valuable insights into the management of MABP, particularly in centers where ELC cannot be fully implemented due to logistical and clinical constraints, worsened by the COVID-19 pandemic. Regardless of the admitting ward, prompt access to surgical care is crucial in reducing the risk of early recurrence, highlighting the need to implement surgical consultation pathways within MABP care bundles. The online version contains supplementary material available at 10. 1007/s00068-024-02748-9.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Acute biliary pancreatitis ; Mild ; Early cholecystectomy ; Recurrence ; Readmission ; Guidelines
Publicat a:	European Journal of Trauma and Emergency Surgery, Vol. 51 (january 2025) , ISSN 1863-9941

DOI: 10.1007/s00068-024-02748-9
PMID: 39821370

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