Poor level of agreement on the management of postoperative pancreatic fistula: results of an international survey

AbstractObjectivesThe occurrence of postoperative pancreatic fistula (POPF) is the main cause of severe complications, including death, after pancreatic surgery. This study was conduced to evaluate current practice in the management of POPF after Whipple surgery and distal pancreatectomy (DP).MethodsAn online survey endorsed by the European–African Hepato‐Pancreato‐Biliary Association (E‐AHPBA) was conducted among surgical departments active in pancreatic surgery. A total of 108 centres were contacted by e‐mail. The survey focused on the use and timing of drainage, nutrition strategies, provision of somatostatin and antibiotic therapies, imaging strategy and indications for reoperation when POPF is diagnosed after pancreatic surgery.ResultsA total of 55 centres (51%) completed the survey. Overall, responses showed poor agreement among centres (Fleiss' kappa: <0.40) on 89% of items after Whipple surgery and 78% of items after DP. There was very poor or no agreement (Fleiss' kappa: