A nationwide survey of acute pancreatitis:a report from 126 hospitals in China
10.3760/cma.j.cn112139-20210414-00169
- VernacularTitle:急性胰腺炎诊疗实践的调查研究
- Author:
Zhigang XUE
1
;
Feng CAO
;
Ang LI
;
Fei LI
Author Information
1. 首都医科大学宣武医院普通外科 首都医科大学急性胰腺炎临床诊疗与研究中心 科技部国家老年疾病临床医学研究中心，北京 100053
- Keywords:
Pancreatitis;
Diagnosis;
Severity evaluation;
Surgical intervention;
Infected pancreatic necrosis
- From:
Chinese Journal of Surgery
2021;59(8):672-678
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the current status of acute pancreatitis(AP) diagnosis and treatment in hospitals of different levels in China.Methods:A cross-sectional survey was conducted. The Acute Pancreatitis Diagnosis and Treatment Practice Questionnaire was designed and sent to the members of Chinese Pancreatic Surgery Association, Chinese Society of Surgery, Chinese Medical Association and some other hospitals online from 8 th to 24 th December, 2020. Observation indicators included general information, AP diagnosis and assessment, treatment strategies, follow-up information, and comparisons of clinical practice between 3A-level and non-3A-level hospitals were performed. Counting data was analyzed by χ 2 test or Fisher exact test. Results:A total of 126 valid questionnaires were collected in final analysis, of which 75.4%(95/126) were from 3A-level hospitals, 15.9%(20/126) and 8.7%(11/126)were from other third-level and second-level hospitals,respectively. Of all participants, 88.1%(111/126) used classic AP diagnostic criteria, and 88.1% (111/126)conducted severity assessment. The revised Atlanta classification and determinant-based classification were commonly used, accounting for 72.1%(80/111) and 22.5%(25/111), respectively. 70.6%(89/126)used predictive models, including APACHE Ⅱ score, imaging models(modified CT severity index or Balthazar scoring) and Ranson criteria. For patients with early pancreatic or peripancreatic infection, 75.4%(95/126) preferred antibiotic therapy, and for those with infected walled-off necrosis, 61.1% (77/126) preferred percutaneous catheter drainage.When surgical intervention required,preferred methods were laparoscopic transabdominal surgery(37.3%, 47/126) and open surgery(25.4%,32/126). A total of 61.1%(77/126) accepted “delayed surgery” notion and 32.5%(41/126) routinely used the step-up approach. For mild biliary acute pancreatitis, 44.4%(56/126) underwent cholecystectomy during the same hospital admission. Regarding follow-up, ideal overall follow-up periods were 6 months(46.0%,57/124) and 12 months(33.1%, 41/124), and follow-up interval was 3 months(50.8%,63/124) and 1 month(23.4%, 29/124). Compared with non-3A-level hospitals, there was higher proportion of annual AP admission number of over 100(34.7%(33/95) vs.12.9%(4/31), χ 2=5.372, P=0.020), a higher proportion of routine severity assessment(68.4%(65/95) vs. 35.5%(11/31), χ2=11.107, P=0.004), and a higher proportion of routine severity prediction(45.3%(43/95) vs. 12.9%(4/31), χ2=13.549, P=0.001) in 3A-level hospitals. When surgical intervention required, the proportion of step-up approach was significantly higher(37.9%(36/95) vs.16.1%(5/31), χ 2=8.512, P=0.017). Significantly more participants preferred that follow-up should be completed by full-time staff(35.8%(34/95) vs. 22.6%(7/31), χ2=8.154, P=0.043) in 3-A level hospitals. Conclusions:The standardization of AP diagnosis is relatively high in China. However, standardized assessment of severity and prediction need to be further prompted, especially in non-3A-level hospitals. Regarding AP treatment, especially the minimally invasive intervention strategy would be the focus of the promotion of standardized AP practice in the future.
