(Non-)compliance with guidelines for the management of severe acute pancreatitis among German surgeons.

BACKGROUND: Implementation of guidelines for the therapy of acute pancreatitis (e.g. those of the International Association of Pancreatology, IAP) into clinical practice has been assumed but not been evaluated. AIM: To verify the knowledge and acceptance of guidelines for the management of severe acute pancreatitis among German surgeons.
METHODS: A questionnaire consisting of five short questions concerning key points in the management of severe acute pancreatitis was sent to the chairmen of the departments of general and visceral surgery of 39 university and 316 non-university hospitals in Germany. An additional, more detailed questionnaire accompanied the audit of the university chairmen.
RESULTS: The response rate was 62%. 11% stated that they strictly followed all guidelines (IAP recommendations No. 2-6), 31% followed all but one recommendation, 31% did not follow 2 or more of the guidelines, and the answers of 27% suggested that their treatment differed substantially from the guideline recommendations. For example, fine needle aspiration biopsy, recommended to differentiate between infected and sterile necrosis in patients with signs of sepsis, was not performed by 55%, and prophylactic antibiotics, recommended to prevent secondary infection of pancreatic necrosis, were not given by 20%.
CONCLUSION: German surgeons know the IAP recommendations for the management of severe acute pancreatitis and have implemented these guidelines in clinical practice. This, however, does not mean that all guideline concepts are strictly followed.