[A nationwide survey of acute pancreatitis:a report from 126 hospitals in China].

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 the Group of Pancreatic Surgery Chinese Society of Chinese Medical Association Branch and some other hospitals online from 8th to 24th 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 used 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). 61.1%(77/126) accepted delayed surgery notion. 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). Comparing clinical practice of AP between 3A-level hospitals and non-3A-level hospitals, we found that the former had a significantly 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), and higher proportion of routine severity assessment(68.4%(65/95) vs. 35.5%(11/31), χ²=11.107, P=0.004), higher proportion of routine severity prediction(45.3%(43/95) vs. 12.9%(4/31), χ²=13.549, P=0.001). 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.