390 Influence of Referral Pathways and Consultant Subspecialty on Morbidity and Mortality in Acute Severe Pancreatitis: A Multicentre Observational Study

Abstract Aim To evaluate the impact of referral pathways and admitting consultant subspecialty on patient outcomes in acute severe pancreatitis (ASP). Method We conducted a retrospective analysis of 75 patients admitted with ASP across 4 district general hospitals from January 2020 to December 2024. Data were collected on demographics, referral pathways, complications and consultant subspecialty. Chi-square tests assessed associations between categorical variables. Multivariable logistic regression models were used to adjust for confounders including age, ASA score, frailty, ITU admission and early complications. Results Morbidity was significantly associated with the admitting consultant subspecialty (p = 0.0108). Patients under Lower Gastrointestinal (LGI) teams experienced the highest morbidity (18/26, 69%), compared to Upper Gastrointestinal (UGI) (19/42, 45%). Mortality, however, did not differ significantly by subspecialty (p = 0.2343). Age over 65 was independently associated with increased mortality (p = 0.0179). Idiopathic pancreatitis was the most common aetiology (40%) and was significantly associated with morbidity (p = 0.0100), mortality (p = 0.0086) and ITU admission (p < 0.0001). Referral to tertiary centres and subsequent acceptance were not independently associated with morbidity or mortality in either univariate or multivariable analyses. Conclusions Admitting consultant subspecialty significantly influences morbidity in patients with ASP, with highest rates seen in UGI-led admissions. While mortality was not significantly impacted by subspecialty or referral status, older age and DNAR decisions were strong predictors of death. These findings support the need for standardised ASP care protocols across subspecialties and underscore the importance of early frailty and escalation planning.