Disparities in the management and prophylaxis of surgical site infection and pancreatic fistula after pancreatoduodenectomy.

Background: Pancreatoduodenectomy (PD) carries a high morbidity. Over time, pancreatic surgeons have altered their perioperative management in efforts to reduce morbidity rates, thereby creating major technical and management variations. We aim to evaluate the practice patterns of hepato-pancreato-biliary (HPB) surgeons across multiple regions worldwide.

Methods: Between May and August 2015, an anonymous 25-item survey questionnaire was electronically distributed to the International Hepato-Pancreato-Biliary Association members regarding practice patterns and perioperative care of patients undergoing PD. Responses were analyzed based on three variables: geographical region, institution type and volume status.

Results: Among 285 participants, the majority were high-volume surgeons (80.4%) at academic institutions (56.1%) from the United States (34.7%), Europe (28.1%) and Asia (14.3%). North American surgeons are more likely to limit prophylactic antibiotic within 24 h postoperatively (P < 0.001), whereas European surgeons more often culture bile intraoperatively (P = 0.024). There are significant variations between different institution types and HPB surgeons based on case volume. Very-high volume surgeons (>50 cases/year) are more likely to routinely culture intraoperative bile (64% vs. 33.3-37.5%) and close incision with subcuticular sutures (42.5% vs. 15.3-25.9%).

Conclusions: Our survey demonstrated significant heterogeneity in perioperative management between HPB surgeons across different regions worldwide. Further studies are warranted to assess the impact of these variations on outcomes of patients undergoing PD. Efforts should be directed towards standardization of perioperative management of PD.