Perioperative management of pancreatoduodenectomy patients: Are North American practices any different? A survey involving IHPBA/AHPBA members.

Abstract

447 Background: Pancreatoduodenectomy is performed worldwide with significant variations in the perioperative management. The aim of this study is to evaluate the practice patterns across regions of the world. Methods: A pilot cross-sectional 25-item survey questionnaire was electronically distributed using Survey Monkey to IHPBA and AHPBA members between May and August 2015 regarding practice patterns and perioperative care of patients undergoing pancreatoduodenectomy. Results: A total of 285 responses were obtained. The majority of participants were from United States (34.7%), Europe (28.1%) and Asia (14.3%). North American (NA) surgeons are less likely to culture intraoperative bile (36.5% vs. 53.1%, p<0.02), routinely check postoperative drain amylase (80.5% vs. 91.3%, p<0.03) or irrigate the wound with Betadine solution (7.7% vs. 29.1%, p<0.001) as compared to European members. Overall, NA surgeons are more likely to use 1 drain (46.3% vs. 88.7% other regions (2 drains), p<0.001), limit the prophylactic antibiotic use within 24 hours of surgery (70.1% vs. 68.5%, p<0.001) and do not culture drain fluid routinely (91.5% vs. 67.1%, p<0.001). Conclusions: Our survey evaluated a wide range of practice patterns globally amongst surgeons performing pancreatoduodenectomy. North American surgeons do not routinely check for amylase rich fluid in the drains, utilize one drain routinely when compared to European surgeons. Further studies are warranted to evaluate if these variations translate into impacts upon surgical outcomes on patients undergoing Whipple operation.