National Survey of Fluid Therapy in Acute Pancreatitis: Current Practice Lacks a Sound Evidence Base

• Published in: World journal of surgery 2013-10, Vol.37 (10), p.2428-2435
• Main Authors: Haydock, Matthew D., Mittal, Anubhav, van den Heever, Marc, Rossaak, Jeremy I., Connor, Saxon, Rodgers, Michael, Petrov, Maxim S., Windsor, John A.
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Acute Disease; Acute Pancreatitis; Attitude of Health Personnel; Cardiac Surgery; Evidence-Based Medicine; Fluid Therapy; Fluid Therapy - methods; Fluid Therapy - standards; Fluid Therapy - statistics & numerical data; Fluid Therapy - utilization; General Surgery; General Surgery - methods; General Surgery - standards; General Surgery - statistics & numerical data; Guideline Adherence - statistics & numerical data; Health Care Surveys; Humans; Medicine; Medicine & Public Health; New Zealand; Organ Failure; Pancreatitis - therapy; Practice Guidelines as Topic; Practice Patterns, Physicians' - statistics & numerical data; Surgery; Systemic Inflammatory Response Syndrome; Thoracic Surgery; Vascular Surgery
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-013-2105-7

Background Fluid therapy (FT) is a critical intervention in managing acute pancreatitis (AP). There is a paucity of evidence to guide FT and virtually no data on current prescribing practice. This survey aims to characterize current practice and opinion with regard to FT in AP throughout New Zealand. Methods Information was collected on fluid selection, administration, and goal-directed FT. The survey was distributed online and in print to all doctors employed in General Surgery Departments in New Zealand on 1 May 2012. Monthly email reminders were sent for 6 months. Results The overall response rate was 47 % ( n  = 190/408). Crystalloids were the preferred initial fluid for all categories of severity; however, colloid use increased with severity ( p  4 L for AP with organ failure (OF). Clinicians treating 26–50 patients per year with AP were less likely to prescribe colloid for AP with OF (8 vs 43 %) ( p  = 0.001). Rate of fluid administration in AP with OF varied according to physicians’ seniority ( p  = 0.004); consultants prescribed >4 L more than other groups (83 vs 68 %). Only 17 % of respondents reported the use of guidelines. Conclusions This survey reveals significant variation in prescription of FT for AP, and aggressive FT is commonly prescribed for AP with OF. There is little adherence to published guidelines or best available evidence.