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).

coMpliAnce with evideNce-based cliniCal guidelines in the managemenT of acute biliaRy pancreAtitis): The MANCTRA-1 international audit / M. Podda, D. Pacella, G. Pellino, F. Coccolini, A. Giordano, S. Di Saverio, F. Pata, B. Ielpo, F. Virdis, D. Damaskos, B. De Simone, F. Agresta, M. Sartelli, A. Leppaniemi, C. Riboni, V. Agnoletti, D. Mole, Y. Kluger, F. Catena, A. Pisanu, C. Gerardi, D. Damaskos, S. Gourgiotis, G. Poillucci, K. Jayant, L. Ferrario, M.P. Calvo, M. Wilson, F. Soggiu, A. Hamdan, C.A. Gomes, G. Fraga, A. Ioannidis, Z. Demetrashvili, S. Sahani, L. Bains, A. Khamees, H. Ababneh, O. Aljaiuossi, S. Pimentel, I.S. Mohamad, A.R. Yusoff, N.O. Zarnescu, V. Calu, A. Litvin, D. Lesko, A. Elmehrath, M. Elshami, M. de Santibanes, J. Gundara, K. Alawadhi, R. Lui, A. Julianov, S. Ralon, I.-. Garzali, G.M. Machain, D.A. Quispe-Cruz, A.C.C. Orantia, M. Waledziak, T. Correia de Sa, S.M. Ali, B. Kovacevic, C. Noel, H.M. Abdalah, A. Kchaou, A. Isik, L. Ansaloni, W. Biffl, M. Guerrieri, A. Sartori, M. Abradelo, G. Nigri, N. Di Lorenzo, A. Mingoli, M. Chiarugi, J. Di Menno Stavron, O. Mazza, J.I. Valenzuela, D. Alendra, F.A. Alvarez, J.E. Liano, J. Tefay, A. Alshaikh, L. Hasan, C. Augusto Gomes, F.C. Gomes, G.P. Fraga, T.R.A. Calderan, E.S. Hirano, D. Dardanov, A. Saroglu, B. Atanasov, N. Belev, N. Kovachev, S.M. Chan, H.-. Lok, D. Salcedo, D. Robayo, M.A. Trivino, J. Manak, J. de Araujo, A. Sethi, A. Awad, M. Elbadawy, A. Farid, A. Hanafy, A. Nafea, Sherief-Ghozy, A. Salah - Abbas, W. Abdelsalam, S. Emile, A. Elfallal, H. Elfeki, H. Elghadban, A. Shoma, M. Shetiwy, M. Elbahnasawy, S. Mohamed, E.F. Hamed, U.A. Khalil, E. Chouillard, A. Gumbs, A. Police, A. Mabilia, K. Khutsishvili, A. Tvaladze, O. Ioannidis, E. Anestiadou, L. Loutzidou, K. Konstantinidis, S. Konstantinidou, D. Manatakis, V. Acheimastos, N. Tasis, N. Michalopoulos, P. Kokoropoulos, M. Papadoliopoulou, M. Sotiropoulou, S. Kapiris, P. Metaxas, I. Tsouknidas, D. Kefili, G. Petrakis, K. Dakis, E. Alexandridou, K. Dakis, A. Papadopoulos, C. Chouliaras, O. Mouzakis, F. Mulita, I. Maroulis, M. Vailas, T. Triantafyllou, D. Theodorou, E. Lostoridis, E.-. Nagorni, P. Tourountzi, E. Baili, A. Charalabopoulos, T. Liakakos, D. Schizas, A. Kozadinos, A. Syllaios, N. Machairas, S. Kykalos, P. Stamopoulos, S. Delis, C. Farazi-Chongouki, E. Kalaitzakis, M. Giannarakis, K. Lasithiotakis, G. Petra, A. Gupta, N. Medappil, V. Muthukrishnan, J. Kamar, P. Lal, R. Agarwal, M. Magnoli, P. Aonzo, A. Serventi, A. Giuliani, P. Di Lascio, M. Pinto, C. Bergamini, A. Bottari, L. Fortuna, J. Martellucci, A. Cicako, C. Miglietta, M. Morino, D. Delogu, A. Picchetto, M. Assenza, G. D'Ambrosio, G. Argenio, M.F. Armellino, G. Ioia, S. Occhionorelli, D. Andreotti, L. Domenico, D. Luppi, M. Casadei, L. Di Donato, F. Manoochehri, T.R. Lucia Marchese, W. Sergi, R. Manca, R. Murgia, E. Piras, L. Conti, S. Gianazza, A. Rizzi, E. Segalini, M. Monti, E. Iiritano, N.M. Mariani, E. De Nicola, G. Scifo, G. Pignata, J. Andreuccetti, F. Fleres, G. Clarizia, A. Spolini, A. Biloslavo, P. Germani, M. Mastronardi, S. Bogoni, S. Palmisano, N. De Manzini, M.V. Marino, G. Martines, G. Trigiante, E. Lagouvardou, G. Anania, C. Bombardini, D. Oppici, T. Pilia, V. Murzi, E. Gessa, U. Bracale, M.M. Di Nuzzo, R. Peltrini, F. Salvetti, J. Vigano, G. Sganga, V. Bianchi, P. Fransvea, T. Fontana, G. Sarro, V.P. Dinuzzi, L. Scaravilli, M.V. Papa, E. Jovine, G. Ciabatti, L. Mastrangelo, M. Rottoli, C. Ricci, I.S. Russo, A. Aiolfi, D. Bona, F. Lombardo, P. Cianci, R. Bini, O. Chiara, S. Cioffi, S. Cantafio, G. Coretti, E. Licitra, G. Savino, S. Grimaldi, R. Porfidia, E. Moggia, M. Garino, C. Marafante, A. Pesce, N. Fabbri, C.V. Feo, E. Marra, M. Troian, D. Drigo, C. Nagliati, M. Andrea, R. Danna, A. Murgese, M. Crespi, C. Guerci, A. Frontali, L. Ferrari, F. Favi, E. Picariello, A. Rampini, F. D'Acapito, G. Ercolani, L. Solaini, F. Palmieri, M. Cali, F. Ferrara, I.A. Muttillo, E.M. Muttillo, B. Picardi, R. Galleano, A. Badran, O. Ghazouani, M. Cervellera, G. Campanella, G. Papa, A. Di Bella, G. Perrone, G.L. Petracca, C. Prioriello, M. Giuffrida, F. Cozzani, M. Rossini, M. Inama, G. Butturini, G. Moretto, L. Morelli, G. Di Candio, S. Guadagni, E. Cicuttin, C. Cremonini, D. Tartaglia, V. Genovese, N. Cillara, A. Cannavera, A. Deserra, A. Picciariello, V. Papagni, L. Vincenti, G. Bagaglini, G. Sica, P. Lapolla, G. Brachini, D. Bono, A. Nicotera, M. Zago, F. Sammartano, L. Benuzzi, M. Stella, S. Rossi, A. Cerioli, C. Puccioni, S. Olmi, C. Rubicondo, M. Uccelli, A. Balla, A. Guida, P. Lepiane, D. Sasia, G. Giraudo, S. Salomone, E. Belloni, A. Cossa, F. Lancellotti, R. Caronna, P. Chirletti, P. Saullo, R. Troiano, F. Mucilli, M. Barone, M. Ippoliti, M. Grande, B. Sensi, L. Siragusa, M. Ortenzi, A. Santini, I. Di Carlo, M. Veroux, R. Gioco, G. Veroux, G. Curro, M. Ammendola, I. Komaei, G. Navarra, V. Tonini, L. Sartarelli, S. Vaccari, M. Ceresoli, S. Perrone, L. Roccamatisi, P. Millo, R.B. Contul, E. Ponte, M. Zuin, G. Portale, A.S. Tonello, G. Fratini, M. Bianchini, B. Perotti, E. Doria, E.G. Lunghi, D. Visconti, K. Al-Shami, S. Awadi, M.M. Khalil Buwaitel, M.F. Naief Naffa', A. Samhouri, H. Sawalha, A. Ramzi Yusoff, M.F. Che Ani, I.N. Ahmed Fathil, J. Huei, A.D. Zakaria, M.Z. Ya'Acob, J.-. Beristain-Hernandez, A. Garcia-Meza, R. Sepulveda-Rdriguez, E.E. Lozada Hernandez, C.L. Acuna Pinzon, J.N. Condoy, F.C. Becerra Garcia, M. Sadik, Jalpa, B. Kadir, J. Devi, N. Seerani, Zainab, M.S. Asghar, A. Afzal, A. Akbar, H.S. Lohse, H.S. Lohse, D. Artidoro Quispe-Cruz, Z.S. Leon Cabrera, G.S. Yamamoto Seto, J.R. Chiuyari, J. Ordemar, M. Rodriguez, A.C.C. Orantia-Carlos, M.A. Quitoy, A. Kwiatkowski, M. Mawlichanow, M. Rocha, C. Soares, S. Muhammad Ali, A. Diana Draghici, A.D. Draghici, V.T. Grigorean, R.B. Radulescu, R.V. Costea, E.C. Zarnescu, M. Kurtenkov, G. Gendrikson, V. Alla-Angelina, T. Arina, A. Kaldarov, M. Gachabayov, A. Abdullaev, M. Milentijevic, M. Karamarkovic, A. Panyko, J. Radonak, M. Soltes, L. Alvarez Moran, H.C. Garcia, P.S. Vega, S. Estevez, Fabio-Ausania, J. Farguell, C. Gonzalez-Abos, S. Sanchez-Cabus, B. Martin, V. Molina, L. Oms, L. Ilzarbe, E.P. Feijoo, E.S. Perra, N. Rojas-Bonet, R. Penalba-Palmi, S. Perez-Bru, J. Tur-Martinez, A. Alvarez-Torrado, M. Domingo-Gonzalez, J. Tejedor-Tejada, M. Di Martino, Y. Garcia del Alamo, F. Mendoza-Moreno, F. Garcia-Moreno-Nisa, B. Matias-Garcia, M. Duran, R. Calleja-Lozano, J.M. Perez de Villar, L. Sanchez-Guillen, I. Caravaca, D. Triguero-Canovas, A.C. Maya Aparicio, B.D. Melendez, A.M. Palacios, A. Landaluce-olavarria, M. De Francisco, B. Estraviz-Mateos, F. Alconchel, T. Nicolas-Lopez, P. Ramirez, V.D. Munoz-Cruzado, F.P. Ciuro, E. Perea del Pozo, S.O. Pizarro, V.H. Cabrera, J.M. Bayo, H.K.S. Hamid, R. Roesel, A. Cristaudi, K. Abbas, I. Ali, A. Tlili, H. Bayhan, M.A. Turkoglu, M.Y. Uzunoglu, I.F. Azamat, N. Omarov, D.S. Uymaz, F. Altintoprak, E. Akin, N. First, K. Das, N. Ozer, A. Seker, Y. Kara, M.A. Bozkurt, A. Kocatas, S.D. Atici, M. Akalin, B. Calik, E. Colak, Y. Altinel, S. Meric, Y.E. Aktimur, V. Hudson, J.-. Duval, M. Khan, A. Saad, M. Kaur, A. Bradley, K. Fox, I. Tomasi, D. Beasley, A.K. Prasanti, P. Kotecha, H. Ebied, M. Paul, H. Sheth, I. Gerogiannis, M. Gaber, Z. Sheikh, S. Seth, M. Kunitsyna, C.A. Leo, V. Bellato, N. Zafar, A. Elserafy, G. Bond-smith, G. Tebala, P. Mathur, I. Abid, N. Chidumije, P. Sandhar, S.O. Zohaib Ullah, T. Lezama, M.H. Anwaar, C. Magee, S. Ahmed, B. Davies, J. Apollos, K. Mccormack, H. Choudhary, T. Doulias, T. Morrison, A. Palepa, F.B. Cal, L. Sanchez, F. Dominguez, I. Al-Raimi, H. Alshargabi, A. Meead. - In: PANCREATOLOGY. - ISSN 1424-3903. - 22:7(2022 Nov), pp. 902-916. [10.1016/j.pan.2022.07.007]

coMpliAnce with evideNce-based cliniCal guidelines in the managemenT of acute biliaRy pancreAtitis): The MANCTRA-1 international audit

L. Ferrario;N.M. Mariani;G. Scifo;S. Palmisano;L. Scaravilli;M. Rottoli;I.S. Russo;O. Chiara;A. Frontali;F. Sammartano;L. Benuzzi;C. Rubicondo;
2022

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).
Acute pancreatitis; Biliary pancreatitis; Global surgery; Guidelines compliance; International audit
Settore MED/18 - Chirurgia Generale
12-lug-2022
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