The first 72 hours of acute pancreatitis: patterns of variability in early clinical decision-making.
6 affiliations
- 1Grup de Recerca RECERCGAD, Institut de Recerca Biomèdica Catalunya Sud (IRB CatSud), Universitat Rovira I Virgili (URV), Servei de Cirurgia General I de L'Aparell Digestiu, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain.
- 2General and Digestive Surgery Department, University Hospital of Mataro, Mataro, Spain.
- 3Unit of Human Anatomy and Embryology, Department of Morphological Sciences, Faculty of Medicine, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain.
- 4Emergency Surgery Unit, Section of General Surgery, Department of General Surgery, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.
- 5Pompeu Fabra University, Barcelona, Spain.
- 6Grup de Recerca RECERCGAD, Institut de Recerca Biomèdica Catalunya Sud (IRB CatSud), Universitat Rovira I Virgili (URV), Servei de Cirurgia General I de L'Aparell Digestiu, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain. [email protected].
Abstract
Objectives
To assess real-world adherence to evidence-based international guidelines in the early management of acute pancreatitis (AP), and to identify how variability in clinical decision-making is distributed during the first 72 h of care.Methods
This multicentre, cross-sectional survey was conducted among consultant physicians and trainees in General Surgery, Gastroenterology, and Emergency Medicine actively practising in Catalonia, Spain. An expert-reviewed 21-item questionnaire assessed self-reported practices across eight key domains of early AP management relative to international consensus recommendations (IAP/APA and WSES). Factors associated with guideline adherence were analysed using chi-square tests and multivariable logistic regression.Results
A total of 165 clinicians clinicians completed the survey. Self-reported adherence to key recommendations was low, particularly for target-directed fluid resuscitation and early oral feeding, while more than half of respondents reported antibiotic use in the absence of confirmed infection. Crucially, clinical practice variability was not uniformly distributed. The greatest differences were observed in time-sensitive, treatment-related decisions, particularly fluid resuscitation and nutritional strategies, where adherence varied significantly according to clinician experience and hospital size. In contrast, antibiotic use showed no significant variation across subgroups, indicating a consistent and widespread deviation from guideline recommendations. On multivariable analysis, overall adherence was independently associated with clinician experience (p = 0.035) and hospital size (p = 0.009), but not with medical speciality or clinician age.Conclusions
Early AP management showed substantial variation in self-reported practice across clinical domains. Variability was greatest for time-sensitive therapeutic decisions, whereas antibiotic overuse appeared to represent a widespread pattern of non-concordant practice across subgroups. Structured local pathways and decision-support tools may help reduce these implementation gaps.
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BibTeX
@article{rodrigo2026first,
title = {{The first 72 hours of acute pancreatitis: patterns of variability in early clinical decision-making.}},
author = {Marta Rodrigo Rodrigo and Nil Gómez Vallvé and Sandra López Gordo and Ana-María González-Castillo and Mihai Pavel and Erik Llàcer and Laia Estalella and Maria Alejandra Guerrero and Robert Memba and Rosa Jorba I Martín and Elena Ramírez-Maldonado},
journal = {World journal of emergency surgery : WJES},
year = {2026},
month = aug,
doi = {10.1186/s13017-026-00720-z},
url = {https://europepmc.org/article/MED/42958561},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - The first 72 hours of acute pancreatitis: patterns of variability in early clinical decision-making.
AU - Marta Rodrigo Rodrigo
AU - Nil Gómez Vallvé
AU - Sandra López Gordo
AU - Ana-María González-Castillo
AU - Mihai Pavel
AU - Erik Llàcer
AU - Laia Estalella
AU - Maria Alejandra Guerrero
AU - Robert Memba
AU - Rosa Jorba I Martín
AU - Elena Ramírez-Maldonado
PY - 2026
DA - 2026/08/02
JO - World journal of emergency surgery : WJES
DO - 10.1186/s13017-026-00720-z
UR - https://europepmc.org/article/MED/42958561
AB - Objectives To assess real-world adherence to evidence-based international guidelines in the early management of acute pancreatitis (AP), and to identify how variability in clinical decision-making is distributed during the first 72 h of care.Methods This multicentre, cross-sectional survey was conducted among consultant physicians and trainees in General Surgery, Gastroenterology, and Emergency Medicine actively practising in Catalonia, Spain. An expert-reviewed 21-item questionnaire assessed self-reported practices across eight key domains of early AP management relative to international consensus recommendations (IAP/APA and WSES). Factors associated with guideline adherence were analysed using chi-square tests and multivariable logistic regression.Results A total of 165 clinicians clinicians completed the survey. Self-reported adherence to key recommendations was low, particularly for target-directed fluid resuscitation and early oral feeding, while more than half of respondents reported antibiotic use in the absence of confirmed infection. Crucially, clinical practice variability was not uniformly distributed. The greatest differences were observed in time-sensitive, treatment-related decisions, particularly fluid resuscitation and nutritional strategies, where adherence varied significantly according to clinician experience and hospital size. In contrast, antibiotic use showed no significant variation across subgroups, indicating a consistent and widespread deviation from guideline recommendations. On multivariable analysis, overall adherence was independently associated with clinician experience (p = 0.035) and hospital size (p = 0.009), but not with medical speciality or clinician age.Conclusions Early AP management showed substantial variation in self-reported practice across clinical domains. Variability was greatest for time-sensitive therapeutic decisions, whereas antibiotic overuse appeared to represent a widespread pattern of non-concordant practice across subgroups. Structured local pathways and decision-support tools may help reduce these implementation gaps.
SN - 1749-7922
ER -