Survey of the management of acute pancreatitis in surgical departments in Sweden

Abstract

Objective: Several international guidelines concerning the treatment of acute pancreatitis has been published during the last decades. However, Scandinavian guidelines are still lacking. The aim of the present study is to identify current treatment strategies for acute pancreatitis in Sweden and to evaluate if there is a need for improvement and the role of guidelines.

Material and methods: A questionnaire was e-mailed to the surgical departments at all Swedish hospitals (n = 58) managing patients with acute pancreatitis. Comparisons were made both between university and non-university hospitals, and between hospitals with more versus less than 150,000 persons in the primary catchment population.

Results: Fifty-one hospitals responded (88%). In median, 65 (12-200) patients with acute pancreatitis are treated yearly at each hospital. Of 51 hospitals, 18 perform a severity classification, with APACHE II being the most commonly used. A majority are of the opinion that a scoring system is not better than the judgment of a senior consultant. In severe acute pancreatitis, 29/48 routinely administer antibiotics, 29/48 use enteral nutrition, and 25/49 have a standardized follow-up plan. The majority considered administration of intravenous fluids as the most important treatment in severe acute pancreatitis. After mild gallstone-induced acute pancreatitis, the corresponding response was cholecystectomy, especially at larger hospitals (p = 0.002). Of 47, 42 are interested in developing a Scandinavian quality register.

Conclusions: The results from this first Swedish national survey provide an insight into current traditions of treatment of acute pancreatitis and points, for example, at the lack of early severity stratification. A majority of hospitals are interested in developing a quality register in acute pancreatitis.