Introduction. Surgical treatment of patients with urgent abdominal surgical pathology is associated with a high risk of developing various somatic complications. The most common of them is acute kidney injury (AKI), which is an independent factor in increasing the duration of hospitalization and mortality.The objective was to develop a prognostic model of individual risk of AKI after surgical treatment of patients with urgent abdominal surgical pathology.Materials and methods. A cohort comparative study of the treatment outcomes of 271 patients with urgent abdominal surgical pathology was conducted. The primary endpoint was the development of AKI. The main group included patients (N = 134) whose early postoperative period was complicated by AKI, and the control group (N = 137) included patients without this complication. Binary logistic regression analysis was used to build a model for predicting the probability of AKI development, which included statistically significant predictors. ROC analysis was performed to determine the sensitivity and specificity of the resulting individual risk model for AKI.Results. It was proven that type 2 diabetes mellitus (p = 0.003), early stages of chronic kidney disease (p = 0.026), and mechanical jaundice (p < 0.001) were significantly more often verified in patients of the main group. In the AKI group, the levels of creatinine (p < 0.001), urea (p < 0.001) and proinflammatory cytokines – tumor necrosis factor alpha (p < 0.001) and C-reactive protein (p < 0.001) were significantly higher. Based on the obtained results, a model for predicting the individual risk of AKI was developed using binary logistic regression analysis, the sensitivity and specificity of which were 82.8% and 88.3%, respectively. High validity of the proposed model was proven.Conclusion. The proposed model allows predicting a reliable individual risk of acute kidney injury after surgical treatment of patients with urgent abdominal surgical pathology.

Нарушения системы свертывания крови в периоперационный период представляют серьезный риск развития жизнеопасных осложнений. В статье представлены методические рекомендации Федерации анестезиологов и реаниматологов России по периоперационному ведению пациентов с нарушениями системы гемостаза, в которых обобщены аспекты как диагностики и оценки, так и интенсивной терапии врожденных и приобретенных нарушений системы свертывания в периоперационный период. Поиск литературы был сосредоточен на метаанализах и рандомизированных контролируемых исследованиях, но также включал регистры, нерандомизированные сравнительные и описательные исследования, серии случаев, когортные исследования, систематические обзоры и мнения экспертов. Описаны принципы периоперационного ведения синдрома диссеминированного внутрисосудистого свертывания, печеночной, уремической, травматической, септической коагулопатии, приобретенных тромбоцитопений и тробоцитопатий, антифосфолипидного синдрома, гемофилий А и В, болезни Виллебранда и другой патологии. Для каждой рекомендации представлен уровень достоверности доказательств и уровень убедительности доказательств. Рекомендации разработаны экспертами в области периоперационного ведения пациентов для врачей анестезиологов-реаниматологов в качестве помощи в принятии клинических решений, окончательное решение по конкретному пациенту принимается лечащим врачом.

Perioperative coagulation disorders pose a serious risk of life-threatening complications. The article presents methodological recommendations of the Federation of Anesthesiologists and reanimatologists of Russian Federation for the perioperative management of patients with disorders of the hemostatic system, which summarizes aspects of both diagnosis and assessment, and intensive care of congenital and acquired disorders of the coagulation system in the perioperative period. The literature search focused on meta-analyses and randomized controlled trials, but also included registries, non-randomized comparative and descriptive studies, case series, cohort studies, systematic reviews, and expert opinion. The principles of perioperative management of disseminated intravascular coagulation syndrome, hepatic, uremic, traumatic, septic coagulopathy, acquired thrombocytopenia and trobocytopathies, antiphospholipid syndrome, hemophilia A and B, von Willebrand disease and other pathologies are described. For each recommendation, the level of certainty of the evidence and the level of strength of the evidence are presented. The recommendations were developed by experts in the field of perioperative patient management for anesthesiologists and intensive care physicians as a help in making clinical decisions; the final decision for a particular patient is made by the attending physician.

АКТУАЛЬНОСТЬ: Ведущее место в структуре послеоперационных осложнений занимает послеоперационная пневмония. Учитывая распространенность послеоперационной пневмонии и рост числа хирургических процедур, прогнозирование ее развития является актуальной задачей, позволяющей принять меры по снижению частоты ее возникновения, путем оптимизации периоперационного периода. Несмотря на свою ценность, существующие шкалы прогнозирования послеоперационной пневмонии не обеспечивают отечественных специалистов надежным и постоянным методом, с помощью которого можно стратифицировать риск развития послеоперационной пневмонии в нашей популяции. ЦЕЛЬ ИССЛЕДОВАНИЯ: разработка модели прогнозирования послеоперационной пневмонии на основе выявления факторов риска ее развития. МАТЕРИАЛЫ И МЕТОДЫ: Многоцентровое проспективное исследование, 6844 пациента старше 18 лет, подвергающиеся плановым оперативным вмешательствам на органах брюшной полости. Оценивали 30-дневную летальность и послеоперационную пневмонию. На первом этапе исследования проводилось сравнение между группой с пневмонией и группой без пневмонии исходных данных пациентов, а также факторов, связанных с операцией и анестезией. На втором этапе исследования проводился логистический регрессионный анализ для оценки вклада факторов в развитие послеоперационной пневмонии. На третьем этапе исследования выполнялось построение модели прогнозирования послеоперационной пневмонии по данным многомерного логистического регрессионного анализа. На заключительном этапе производилось сравнение полученной модели с моделями прогнозирования других авторов, встречающихся в мировой литературе. РЕЗУЛЬТАТЫ: Пневмония выявлена у 53 пациентов (0,77 %). Летальный исход наблюдался у 39 пациентов: у пациентов с пневмонией в 15 случаях (28,3 %), а без пневмонии — в 24 случаях (0,4 %). Ретроспективно с учетом полученной модели к группе высокого риска развития пневмонии были отнесены 933 пациента, частота развития пневмонии составляла 4,5 %. В группе низкого риска развития пневмонии — 5911 пациентов, частота развития пневмонии составляла 0,19 %. ВЫВОДЫ: Выявлены восемь независимых переменных, связанных с послеоперационной пневмонией: длительность операции, курение, полная функциональная зависимость, периоперационная анемия, требующая применения препаратов железа, интраоперационное применение вазопрессоров, III функциональный класс по классификации Американского общества анестезиологов, применение бронходилатирующих препаратов по поводу хронической обструктивной болезни легких, высокий операционный риск. Модель прогнозирования послеоперационной пневмонии имеет отличную прогностическую значимость (AUROC = 0,904).

РАННИЕ ЭНДОСКОПИЧЕСКИЕ ВМЕШАТЕЛЬСТВА И РИСК ИНФИЦИРОВАНИЯ У ПАЦИЕНТОВ С БИЛИАРНЫМ ПАНКРЕОНЕКРОЗОМЭкстрем А.В. 1 , Туровец М

АКТУАЛЬНОСТЬ: Оценка риска и выделение группы пациентов с высокой вероятностью развития неблагоприятного исхода — основа эффективной профилактики послеоперационных неблагоприятных событий. ЦЕЛЬ ИССЛЕДОВАНИЯ: определить структуру и частоту сопутствующих заболеваний в предоперационный период и ассоциированные с ними неблагоприятные послеоперационные исходы. МАТЕРИАЛЫ И МЕТОДЫ: Проведен анализ показателей 8241 пациента базы STOPRISK, оперированных на органах брюшной полости и малого таза за период с 1 июля 2019 г. по 30 апреля 2022 г. РЕЗУЛЬТАТЫ: Сопутствующие заболевания встречались у 4638 пациентов (56,3 %), при этом одно заболевание наблюдали у 1872 пациентов (22,7 %), сочетание двух заболеваний — у 1383 пациентов (16,8 %), трех заболеваний — у 814 пациентов (9,9 %), четырех заболеваний — у 395 пациентов (4,8 %), более 4 — у 170 пациентов (2,0 %). Наиболее часто встречались гипертоническая болезнь — 48,2 %, хроническая сердечная недостаточность (20,7 %), ишемическая болезнь сердца (19,3 %). Наличие одного осложнения и более зафиксировано у 285 пациентов (3,5 %), летальный исход — у 36 пациентов (0,43 %). У 74,0 % пациентов наблюдали единственное осложнение, у 14,0 % — сочетание двух осложнений, у 12,0 % — сочетание трех осложнений и более. В структуре осложнений преобладали парез кишечника (25,57 %), пневмония (12,1 %), раневая инфекция (12,1 %). Как летальность, так и частота осложнений росли с увеличением количества сопутствующих заболеваний. ВЫВОДЫ: Наиболее частые сопутствующие заболевания в абдоминальной хирургии — гипертоническая болезнь, хроническая сердечная недостаточность, ишемическая болезнь сердца, сахарный диабет и нарушение сердечного ритма. Частота послеоперационных осложнений составила 3,5 %, летальность — 0,43 %; при этом наиболее частыми осложнениями были парез кишечника, раневая инфекция и пневмония.

The analysis of publications devoted to the pathogenesis and prediction of the most frequent complications of patients with pancreatic necrosis was carried out. It was revealed that the issues of development and prevention of the described complications require further study, which will help in creating a personalized model for predicting complications necessary to justify preventive measures and reduce the mortality rate in patients of this category.

A significant proportion of patients undergoing non-cardiac surgery receive therapy with angiotensin converting enzyme (ACE) inhibitors/angiotensin II receptor blockers (ARBs), which are usually prescribed for treatment of arterial hypertension and CHF. Current guidelines fail to provide clear consensus on whether it is worth discontinuing ACEi/ARBs before non-cardiac surgery. The aim of this research was to assess the contribution of pre-op ACEi/ARBs withdrawal to the development of postoperative complications in patients after abdominal surgery using data from STOPRISK database.Materials and methods. Data of 1945 patients from of the STOPRISK database was used for the analysis. Patients were retrospectively divided into two groups: first group (N=471, 24.2%) included patients subjected to ACEi/ARBs withdrawal 24 hours before surgery, second group (N=1474, 75.8%) included patients continuing on ACEi/ARBs therapy. The 30-day outcomes were analyzed — postoperative complications (acute kidney injury, acute respiratory distress syndrome, anastomosis failure, arrhythmias, circulatory arrest, cardiogenic pulmonary edema, postoperative delirium, myocardial infarction, pneumonia, ileus, postoperative bleeding, pulmonary embolism, acute cerebrovascular accident, wound infection) and mortality. We were not evaluating intraoperative and postoperative arterial hypotension and hypertension, we analyzed the use of vasopressors as a surrogate marker. ACEi/ARBs re-initiation after surgery was not evaluated.Results. One or more post-operative complications were documented in 113 patients (5.8%). Only postoperative delirium was more common in patients (1.06% vs. 0.27%, P=0.027) after ACEi/ARBs withdrawal 24 hours before surgery, the difference reached statistical significance. Sub-analysis in the group of patients with arterial hypertension as the only comorbidity showed no statistically significant differences in the outcomes. Sub-analysis in the group of patients with CFH showed higher incidence of postoperative delirium after ACEi/ARBs withdrawal (2.68% vs. 0.6%, P=0.023). The logistic regression analysis showed that the risk of developing postoperative delirium is influenced by age, vasopressor support, and ACEi/ARBs withdrawal (the area under the curve for the model was 0.92 (0.90–0.93).Conclusion. Rates of pre-op ACEi/ARBs withdrawal (24.2%) are consistent with published data. In the entire cohort, ACEi/ARBs withdrawal resulted in higher incidence of postoperative delirium, as well as in the subgroup of patients with CHF, while ACEi/ARBs withdrawal in the subgroup of patients with arterial hypertension had no influence on postop complications.ACEi/ARBs withdrawal, along with hemodynamic instability and older age, contributes to the development of postoperative delirium, which is the subject of future research.

INTRODUCTION: Taking into account the prevalence of postoperative pneumonia and the increase in the number of surgical procedures, forecasting its development is an urgent task that allows taking measures to reduce the frequency of its occurrence by optimizing the perioperative period. Despite their value, the existing scales for predicting postoperative pneumonia do not provide domestic specialists with a reliable and consistent method by which to stratify the risk of developing postoperative pneumonia in our population. OBJECTIVE: To develop a model for predicting postoperative pneumonia based on the identification of risk factors for its development. MATERIALS AND METHODS: A multicenter prospective study of 6844 patients over 18 years of age undergoing elective abdominal surgery. 30-day mortality and postoperative pneumonia were assessed. In the first phase of the study, a comparison was made between the pneumonia and non-pneumonia group of baseline patient data, as well as factors associated with surgery and anesthesia. At the second stage of the study, a logistic regression analysis was performed to assess the contribution of factors to the development of postoperative pneumonia. At the third stage of the study, a model for predicting postoperative pneumonia was built according to the data of multivariate logistic regression analysis. At the final stage, the obtained model was compared with the forecasting models of other authors found in the world literature. RESULTS: Pneumonia was detected in 53 patients (0.77 %). A lethal outcome was observed in 39 patients: in patients with pneumonia in 15 cases (28.3 %), and without pneumonia in 24 cases (0.4 %). Retrospectively, taking into account the obtained model, 933 patients were assigned to the high-risk group for developing pneumonia, the incidence of pneumonia was 4.5 %. In the low-risk group for developing pneumonia — 5911 patients, the incidence of pneumonia was 0.19 %. CONCLUSIONS: Eight independent variables associated with postoperative pneumonia were identified: duration of surgery, smoking, complete functional dependence, perioperative anemia requiring iron supplementation, intraoperative use of vasopressors, American Society of Anesthesiologists classification 3 functional class, use of bronchodilators for chronic obstructive pulmonary disease, and high operative risk. The postoperative pneumonia prediction model has excellent predictive value (AUROC = 0.904).

OBJECTIVE:To prevent purulent-septic complications in patients with destructive pancreatitis.MATERIAL AND METHODS:A cohort study included 488 patients with pancreatic necrosis: group 1 (n=331) - active surgical strategy, group 2 (n=157) - follow-up and therapy. We used binary logistic regression to predict purulent-septic complications.RESULTS:Original model of independent variables significantly (p<0.001) revealed 5.3 times higher risk of infectious complications after laparotomy within the first week after hospitalization. Incidence of these events increased by 2.8 times in patients biliary pancreatitis compared to alcohol-alimentary pancreatitis. Complication rate was higher in older patients (by 2.1% for each year). Risk of purulent-septic complications decreased by 57.4% in women compared to men. There was no significant correlation between risk of infectious complications and endoscopic procedures. Specificity and sensitivity of the model was 74.2 and 72.6%, respectively.CONCLUSION:Original model significantly predicts the risk of purulent-septic complications within the first week after hospitalization. Refusal of early active surgical strategy in these patients will significantly reduce the likelihood of purulent-septic complications.

INTRODUCTION: Approaches to sedation in the departments of anesthesiology, intensive care and intensive care have changed over the past 20 years. In 2020, the guidelines “Sedation of patients in the departments of anesthesiology, intensive care and intensive care” were placed in the rubric of clinical recommendations. OBJECTIVE: To contribute to improving the quality of planned updating of recommendations with the help of a modified Delphi analysis of the provisions and quality criteria of the current version of the document published in the rubricator of clinical recommendations of the Ministry of Health of the Russian Federation. MATERIALS AND METHODS: We used a modified Delphi method with two rounds of questionnaires to develop a consensus. The agreement of specialists was reached in three stages: preparatory, discussions and the development of a consensus conclusion. To conduct the assessment, a questionnaire was created consisting of 3 blocks: assessment of the provisions of the clinical recommendation; assessment of the quality criteria of the clinical recommendation and an overall assessment of the clinical recommendation. The assessment was made on the basis of the Likert scale. Median, fashion and weighted average score were calculated. If, when evaluating the provisions and quality criteria of a clinical recommendation, the median value or mode of any provision was less than 7, the weighted average score was less than 70 %; the median value or mode of quality criteria is less than 7.5, the weighted average score is less than 75 %, then this provision (quality criterion) should be recommended for processing. RESULTS: The assessment of the provisions and criteria was carried out in the first round of discussion. At the second round of discussion, comments and recommendations were finally developed for the developers of the methodological recommendation. Consensus was reached during two rounds of modified Delphi analysis. As a result of the analysis, 16 out of 21 provisions and 5 out of 6 quality criteria were agreed, the rest required processing. CONCLUSIONS: As a result of an independent assessment by experts, 5 provisions and 1 quality criterion were recommended for processing. Comments and recommendations on all these provisions and quality criteria of the methodological recommendation “Sedation of patients in the departments of anesthesiology, intensive care and intensive care” were also agreed.

INTRODUCTION: Risk assessment and identification of a group of patients with a high probability of developing an unfavorable outcome is the basis for effective prevention of postoperative adverse events. OBJECTIVE: The purpose of the study was to determine the structure and frequency of co-existing diseases in the preoperative period and associated adverse postoperative outcomes. MATERIALS AND METHODS: The analysis of the parameters of 8,241 patients of the STOPRISK database operated on abdominal and pelvic organs for the period from July 1, 2019 to April 30, 2022 was carried out. RESULTS: Co-existing diseases occurred in 4,638 patients (56.3 %), while one disease was observed in 1,872 patients (22.7 %), a combination of two diseases — in 1,383 patients (16.8 %), three diseases — in 814 patients (9.9 %), four diseases — in 395 patients (4.8 %), and more than 4 — in 170 patients (2.0 %). The most common were arterial hypertension — 48.2 %, chronic heart failure (20.7 %), coronary heart disease (19.3 %). The presence of one or more complications was recorded in 285 patients (3.5 %), fatal outcome — in 36 patients (0.43 %). 74.0 % of patients had a single complication, 14.0 % had a combination of two complications, and 12.0 % had a combination of three or more complications. The structure of complications was dominated by paralytic ileus (25.57 %), pneumonia (12.1 %), wound infection (12.1 %). Both mortality and the frequency of complications increased with an increase in the number of co-existing diseases. CONCLUSIONS: The most common co-existing diseases in abdominal surgery are arterial hypertension, chronic heart failure, coronary heart disease, diabetes mellitus and cardiac arrhythmia. The frequency of postoperative complications was 3.5 %, mortality was 0.43 %; the most frequent complications were paralytic ileus, wound infection and pneumonia.

Relevance. The incidence of acute pancreatitis is growing worldwide, being one of the leading causes of hospitalization in urgent surgery. The most common complication of pancreatic necrosis (PN) in the aseptic phase is acute kidney injury (AKI), which is an independent risk factor for an unfavorable outcome. The objective was to develop a personalized risk model for AKI in the aseptic phase of pancreatic necrosis. Materials and methods . A comparative cohort study of the results of treatment of 502 patients with pancreatic necrosis was conducted. The primary endpoint was considered to be the development of AKI, for the development of a personalized model of the probability of its development in sterile pancreatic necrosis, binary logistic regression analysis was used. Results. A model of independent variables was developed that reliably (p < 0.001) determined that with an increase in age by 1 year, the probability of developing AKI increased by 2.3%, and with a history of chronic kidney disease in a patient – by 3.2 times. The same model demonstrates that the risk of AKI in patients with pancreatic necrosis with an increase in glomerular filtration rate by 1 ml·min –1 ·1.73 m 2 and with the use of balanced crystalloid solutions decreased by 5.0% and 3.0 times, respectively. The specificity of the model was 79.8%, sensitivity – 79.1%. Conclusion. The proposed model makes it possible to reliably predict the individual risk of AKI on the first day of hospitalization.

The objective: to develop a predictive model for assessing the risk of developing encephalopathy (EP) in patients with nutritional pancreatic necrosis.Subjects and Methods. A single-center prospective cohort study was conducted at Faculty Surgery Clinic of Volgograd State Medical University from 2010 to 2020. Logistic regression analysis was used to build a model for predicting the risk of developing EP.Results. A total of 429 patients were included in the study. It was determined that in the majority of patients EP manifested in the first three days after hospitalization. A statistically significant predictive model of correlation of the risk to develop EP with clinical and demographic variables showed that an increase in the severity of the patient's condition (according to the SOFA scale) by 1 point increased the risk by 1.9 times, and an increase in bilirubin levels by 1 μmol/l, and urea by 1 mmol/l increased the risk of AED by 8.0% and 28.0%, respectively. In non-alcoholic pancreatic necrosis, compared with the alcoholic genesis of the disease, and when using early (before day 3) enteral nutrition, there was a significant reduction in the risk of developing EP by 175.5% and 137% of cases. The specificity and sensitivity of the model were 78.7% and 82.8%, respectively.Conclusions. In nurtitional pancreatic necrosis, an increase in the severity of the patient's condition, alcoholic genesis of the disease, progression of signs of liver and kidney failure significantly increased the risk of developing EP. At the same time, early enteral nutrition contributed to a significant reduction in the risk of this complication. The presented predictive model is recommended to be used in routine clinical practice.

Aim. To study the influence of systemic disorders on the risk of developing pancreatogenic encephalopathy.Materials and methods.In the period from 2010 to 2020, a prospective non-randomized cohort study was conducted at theclinical base of Department of Faculty Surgery of Volgograd State Medical University. ROC analysis was used to determine the impact of systemic disorders on the risk of developing pancreatogenic encephalopathy (PEP). The influence of the pancreatic necrosis trigger on the risk of multiple organ failure syndrome (MOF) was determined using logistic regression analysis. Results.The study included 429 patients with acute destructive pancreatitis. It was revealed that the debut of systemic disorders occurred on average on the first day of hospitalization. The most common were intestinal and cardiovascular insufficiency –336 (78,3 %) and 242 (56,4 %) cases, respectively. In patients with alcohol-associated pancreatic necrosis (AAPN), intestinal failure was significantly more common [144 (84,7 %) versus 192 (74,1 %),OR = 1,93, CI 1,164–3,210, p= 0,012] and multiple systemic disorders [159 (93,5 %) versus 224 (86,5 %), OR = 1,18, CI 0,659–2,122, p= 0,025] than in patients with non-alcoholic pancreatic necrosis (NAPN).The conducted logistic regression analysis proved an increased risk of PEP in the presence of any organ dysfunction. However, no such relationship was found for acute renal failure. The risk of developing MODS in patients with AAPN increases by 37,5 % compared with patients with non-alcoholic pancreatic necrosis, while the specificity and sensitivity reach 75,3 % and70,0 %, respectively.Conclusions.In patients with alcoholic genesis of pancreatic necrosis, the risk of intestinal failure, as well as multiple systemic disorders, significantly increases. A significant increase in the likelihood of organ and multiorgan disorders in patients with pancreatogenic encephalopathy was revealed.

АКТУАЛЬНОСТЬ: Успехи современной анестезиологии позволили значительно снизить риск осложнений анестезии по сравнению с прошлым веком, однако уровень периоперационной внутрибольничной летальности после плановых обширных абдоминальных операций на данный момент все еще остается высоким. Прогнозирование неблагоприятного исхода является краеугольным камнем индивидуализации периоперационного ведения пациентов высокого риска, направленного на предупреждение осложнений. Несмотря на то что за последние десятилетия разработано большое количество инструментов оценки риска, точность прогноза все еще далека от необходимой. Как показывают данные литературы, наибольшей точностью обладают модели, основанные на изучении факторов риска в национальной популяции пациентов, из которых наибольший вклад вносят сопутствующие заболевания. МАТЕРИАЛЫ И МЕТОДЫ: Проспективное наблюдательное исследование. Условия: Национальное многоцентровое исследование пациентов хирургических стационаров. Пациенты: Пациенты, подвергающиеся оперативным вмешательствам на органах брюшной полости. Вмешательства: Не предусмотрены. РЕЗУЛЬТАТЫ: Разработанный дизайн был зарегистрирован в базе данных ClinicalTrials.gov, в настоящее время исследование, организованное Федерацией анестезиологов и реаниматологов России совместно с Кубанским государственным медицинским университетом, началось, в нем участвует 38 центров, опубликовано две работы по результатам промежуточного анализа. ВЫВОДЫ: Исследование имеет важное научное и медико-социальное значение, в результате анализа полученных данных будут изучена роль сопутствующих заболеваний в развитии неблагоприятного исхода и разработана национальная модель оценки риска.

The objective: development of a method for determining the individual risk of post-ERCP pancreatitis (PEP) before endoscopic intervention.Subjects and Methods. A prospective observational study of the results of therapeutic endoscopic retrograde cholangiopancreatography (ERCP) was performed in 1,210 patients. The primary end point was the development of PEP. Multiple regression logistic analysis was used to determine the risk of developing PEP.Results. A model of independent variables was determined, which significantly (p = 0.0001) affected the risk of developing PEP. Based on the results of the logistic analysis, regression coefficients were calculated for all significant patient-dependent factors (gender, age, preoperative level of amylasemia and bilirubinemia, and nature of the underlying disease). The risk of PEP decreased in men (by 47.5%), with an increase in the age of patients (for 1 year by 2.3%) and bilirubin (with an increase of 1 μmol/l by 0.3%) but increased with an increase in amylase activity blood serum (by 0.7% for each 1 U/l). A formula has been developed to assess the individual risk of PEP at the stage of preparing a patient for therapeutic ERCP.Conclusion. Analysis of patient-dependent factors makes it possible to reliably determine the risk of developing PEP. It was determined that a female gender, young age (under 40 years old), sphincter of Oddi dysfunction increased the risk of PEP, while a male sex, stenting of the main pancreatic duct, and jaundice reduced this risk. The use of the proposed formula will help predict a significant (p = 0.0001) degree of risk of PEP before performing primary therapeutic ERCP in a particular patient.