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).

'Luigi Vanvitelli' University of Campania Naples Italy; Colorectal Surgery Vall d'Hebron University Hospital Barcelona Spain

Centre for Inflammation Research Clinical Surgery University of Edinburgh Edinburgh Scotland UK

Department of Abdominal Surgery Abdominal Center University of Helsinki and Helsinki University Central Hospital Helsinki Finland

Department of Emergency and Metabolic Minimally Invasive Surgery Centre Hospitalier Intercommunal de Poissy Saint Germain en Laye Poissy Cedex France

Department of Emergency and Trauma Surgery Bufalini Hospital Cesena Italy

Department of General Surgery Santo Stefano Hospital Prato Italy

Department of Surgery EOC Regional Hospital Lugano Switzerland

Department of Surgery Macerata Civil Hospital Macerata Italy

Department of Surgery Madonna del Soccorso Hospital San Benedetto del Tronto Italy

Department of Surgery Vittorio Veneto Civil Hospital Vittorio Veneto Italy

Department of Surgical Science Emergency Surgery Unit University of Cagliari Cagliari Italy

Department of Upper GI Surgery Royal Infirmary of Edinburgh Edinburgh Scotland UK

Division of General Surgery Rambam Health Care Campus Haifa Israel

General Emergency and Trauma Surgery Unit Pisa University Hospital Pisa Italy

General Surgery Unit Nicola Giannettasio Hospital Corigliano Rossano Italy

HPB Surgery Unit Hospital del Mar Barcelona Spain

Intensive Care Unit Bufalini Hospital Cesena Italy

Trauma and Acute Care Surgery Unit Niguarda Ca Granda Hospital Milan Italy

University of Naples Federico 2 Department of Public Health Naples Italy

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ClinicalTrials.gov
NCT04747990