401 Peri-Operative Intervention Variability in Open Pancreatoduodenectomy Amongst UK HPB Surgeons

Abstract Aim To evaluate variability in peri-operative interventions and techniques in pancreaticoduodenectomy (PD) among hepatobiliary and pancreatic (HPB) surgeons in the United Kingdom (UK) and Ireland. Method A national cross-sectional survey was distributed to consultant HPB surgeons across the UK and Ireland via google forms. Questions ranged across the entirety of the patients’ journey, though the present addresses peri-operative interventions and techniques including incision type, somatostatin analogue (SSA) use, antibiotic choice, closure technique and post-operative analgesia and care. Responses were analyzed descriptively. Results 38 responses were received, from across 30 different hospitals. Incision preferences varied between midline (13/38,34.2%), rooftop (12/38,31.6%), reverse-L (9/38,23.7%), and Kocher (4/38,10.5%). SSAs were used by 23/38 (60.5%), with varying strategies. Antibiotic regimens varied: 3/38 (7.9%) used single to three peri-operative doses, 3/38 (7.9%) extended to 5-days, and 2/38 (5.3%) limited use to intraoperative only. Regimens were commonly tailored to stent status (26/38, 68.4%), and piperacillin-tazobactam was the most common overall (16/38,42.1%). Closure technique was split between mass closure (20/38,52.6%) and two-layer (17/38, 44.7%). Regional analgesia was common with wound catheters (27/38,71.1%), epidurals (8/38,21.1%) the most common. 31/38 (81.6%) utilised a standard ERAS protocol and 31/38 (81.6%) routinely admit to a HDU or ITU post-operatively. Conclusions: Significant peri-operative variation exists in PD, away from the often-scrutinized pancreatic anastomosis. Whilst such variation may just reflect difference in training and operator preference, little is known on the impact of such variation on patient outcomes. A national, collaborative approach could yield such answers and offer opportunity for marginal-gains in PD outcomes.