title: Canadian practice patterns for pancreaticoduodenectomy.
abstract: BACKGROUND
  Discordant practice patterns may be a consequence of evidence-practice gaps or deficiencies in knowledge translation. We examined the current strategies used by hepato-pancreatico-biliary (HPB) surgeons in Canada for the perioperative management of pancreaticoduodenectomy (PD).
  
  
  METHODS
  We generated a web-based survey that focused on the perioperative measures surrounding PD. The survey was distributed to all members of the Canadian Hepato-Pancreatico-Biliary Association.
  
  
  RESULTS
  The survey was distributed to 74 surgeons and received a response rate of 50%. Many similarities in surgical techniques were reported; for example, most surgeons (86.5%) reconstruct the pancreas with pancreaticojejunostomy rather than pancreaticogastrostomy. In contrast, variable techniques regarding the use of peritoneal drainage tubes, anastomotic stents, octreotide and other intraoperative modalities were reported. Most surgeons (75.7%) reported that their patients frequently required preoperative biliary drainage, yet there was minimal agreement with the designated criteria. There was variability in postoperative care, including the use of epidural analgesia and timing of postoperative oral nutrition.
  
  
  CONCLUSIONS
  We identified heterogeneity among Canadian HPB surgeons, suggesting a number of evidence-practice gaps within specific domains of pancreatic resections. Focused research in these areas may facilitate technical agreement and improve patient outcomes following PD.
authors: The Department of Surgery, University of Toronto and the Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ont.
authors: David P
authors: DP
authors: Cyr
authors: The Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ont.
authors: Jessica L
authors: JL
authors: Truong
authors: The Department of Surgery, University of Toronto and the Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ont.
authors: Jenny
authors: J
authors: Lam-McCulloch
authors: The Department of Surgery, University of Toronto, and the Department of Surgery, University Health Network, Toronto, Ont.
authors: Sean P
authors: SP
authors: Cleary
authors: The Department of Surgery, University of Toronto, and the Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ont.
authors: Paul J
authors: PJ
authors: Karanicolas
mesh_terms: D015360:Analgesia, Epidural / Q000706:statistics & numerical data; D002170:Canada; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D019538:Health Care Surveys; D006801:Humans; D015282:Octreotide / Q000627:therapeutic use; D016577:Pancreaticoduodenectomy / Q000379:methods; D019990:Perioperative Care; D015607:Stents
chemical_list: D005765:Gastrointestinal Agents; D015282:Octreotide