Compliance with evidence-based clinical guidelines in the management of acute biliary pancreatitis: the MANCTRA-1 international audit.
Podda, Mauro Pacella, Daniela Pellino, Gianluca Coccolini, Federico Giordano, Alessio Di Saverio, Salomone Pata, Francesco Ielpo, Benedetto Virdis, Francesco Damaskos, Dimitrios
Podda, Mauro
Pacella, Daniela
Pellino, Gianluca
Coccolini, Federico
Giordano, Alessio
Di Saverio, Salomone
Pata, Francesco
Ielpo, Benedetto
Virdis, Francesco
Damaskos, Dimitrios
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2022-07-16
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Abstract
Background/objectives: Reports about the implementation of recommendations from acute pancreatitis guidelines are scant. This study aimed to evaluate, on a patient-data basis, the contemporary practice patterns of management of biliary acute pancreatitis and to compare these practices with the recommendations by the most updated guidelines.
Methods: All consecutive patients admitted to any of the 150 participating general surgery (GS), hepatopancreatobiliary surgery (HPB), internal medicine (IM) and gastroenterology (GA) departments with a diagnosis of biliary acute pancreatitis between 01/01/2019 and 31/12/2020 were included in the study. Categorical data were reported as percentages representing the proportion of all study patients or different and well-defined cohorts for each variable. Continuous data were expressed as mean and standard deviation. Differences between the compliance obtained in the four different subgroups were compared using the Mann-Whitney U, Student's t, ANOVA or Kruskal-Wallis tests for continuous data, and the Chi-square test or the Fisher's exact test for categorical data.
Results: Complete data were available for 5275 patients. The most commonly discordant gaps between daily clinical practice and recommendations included the optimal timing for the index CT scan (6.1%, χ2 6.71, P = 0.081), use of prophylactic antibiotics (44.2%, χ2 221.05, P < 0.00001), early enteral feeding (33.2%, χ2 11.51, P = 0.009), and the implementation of early cholecystectomy strategies (29%, χ2 354.64, P < 0.00001), with wide variability based on the admitting speciality.
Conclusions: The results of this study showed an overall poor compliance with evidence-based guidelines in the management of ABP, with wide variability based on the admitting speciality. Study protocol registered in ClinicalTrials.Gov (ID Number NCT04747990).
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Podda M, Pacella D, Pellino G, Coccolini F, Giordano A, Di Saverio S, Pata F, Ielpo B, Virdis F, Damaskos D, De Simone B, Agresta F, Sartelli M, Leppaniemi A, Riboni C, Agnoletti V, Mole D, Kluger Y, Catena F, Pisanu A; MANCTRA-1 Collaborative Group; Principal Investigator; Steering Committee; MANCTRA-1 Coordinating Group; Local Collaborators; Argentina; Australia; Bahrain; Brazil; Bulgaria; China; Colombia; Czech Republic; Egypt; France; Georgia; Greece; Guatemala; India; Italy; Jordan; Malaysia; Mexico; Nigeria; Pakistan; Paraguay; Peru; Philippines; Poland; Portugal; Qatar; Romania; Russia; Serbia; Slovak Republic; South Africa; Spain; Sudan; Switzerland; Syria; Tunisia; Turkey; United Kingdom; Uruguay; Yemen. Compliance with evidence-based clinical guidelines in the management of acute biliary pancreatitis: the MANCTRA-1 international audit. Pancreatology. 2022 Nov;22(7):902-916. doi: 10.1016/j.pan.2022.07.007. Epub 2022 Jul 16.
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