Poor level of agreement on the management of postoperative pancreatic fistula: results of an international survey.

Details

Serval ID
serval:BIB_8D785039624C
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Poor level of agreement on the management of postoperative pancreatic fistula: results of an international survey.
Journal
HPB : the official journal of the International Hepato Pancreato Biliary Association
Author(s)
Melloul E., Raptis D.A., Clavien P.A., Lesurtel M.
Working group(s)
European-African Hepato-Pancreato-Biliary Association
ISSN
1477-2574 (Electronic)
ISSN-L
1365-182X
Publication state
Published
Issued date
04/2013
Volume
15
Number
4
Pages
307-314
Language
english
Notes
Publication types: Journal Article ; Multicenter Study
Publication Status: ppublish
Abstract
The occurrence of postoperative pancreatic fistula (POPF) is the main cause of severe complications, including death, after pancreatic surgery. This study was conduced to evaluate current practice in the management of POPF after Whipple surgery and distal pancreatectomy (DP).
An online survey endorsed by the European-African Hepato-Pancreato-Biliary Association (E-AHPBA) was conducted among surgical departments active in pancreatic surgery. A total of 108 centres were contacted by e-mail. The survey focused on the use and timing of drainage, nutrition strategies, provision of somatostatin and antibiotic therapies, imaging strategy and indications for reoperation when POPF is diagnosed after pancreatic surgery.
A total of 55 centres (51%) completed the survey. Overall, responses showed poor agreement among centres (Fleiss' kappa: <0.40) on 89% of items after Whipple surgery and 78% of items after DP. There was very poor or no agreement (Fleiss' kappa: <0.1) on postoperative strategies for the management of nutrition and use of somatostatin after both procedures. In the event of POPF, 42% of centres used total oral nutrition and 22% used somatostatin after Whipple surgery, and 71% used total oral nutrition and 31% used somatostatin after DP. There were significant disagreements between units conducting, respectively, more and fewer than 50 Whipple procedures per year on drain removal after DP, and imaging strategy and patient discharge after Whipple surgery and DP.
This survey discloses important disagreements worldwide regarding the management of POPF after both Whipple surgery and DP. The standardized management of POPF would better facilitate the comparison of outcomes in future trials.

Keywords
Africa/epidemiology, Americas/epidemiology, Asia/epidemiology, Australia/epidemiology, Europe/epidemiology, Health Surveys, Hormones/administration & dosage, Humans, Incidence, Internet, Pancreatectomy/adverse effects, Pancreatectomy/methods, Pancreatic Fistula/epidemiology, Pancreatic Fistula/etiology, Pancreatic Fistula/surgery, Pancreatic Fistula/therapy, Pancreatic Neoplasms/pathology, Pancreatic Neoplasms/surgery, Pancreaticoduodenectomy/adverse effects, Pancreaticoduodenectomy/methods, Reoperation, Somatostatin/administration & dosage, Suction, Surveys and Questionnaires, Treatment Outcome
Pubmed
Open Access
Yes
Create date
15/02/2017 11:45
Last modification date
20/08/2019 15:51
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