title: Are Clinical Guidelines for the Management of Intraductal Papillary Mucinous Neoplasms Followed?: A Single-Center Analysis.
abstract: This study aimed to determine how frequently guidelines for the management of intraductal papillary mucinous neoplasms (IPMNs) are followed and establish factors associated with failure.
  
  
  
  Four hundred forty-five patients with radiographic diagnosis of IPMN 1 cm or greater between January 1, 2003 and January 1, 2013 were included. We defined failure of guideline adherence if the following occurred: (a) failure of acknowledgment of IPMN, (b) failure to undergo endoscopic ultrasound, (c) failure to undergo resection, or (d) failure to undergo at least 1 surveillance image within 2 years after diagnosis.
  
  
  
  Failure of guideline adherence was observed in 58% of patients and evident across all the respective criteria (A: 38%, B: 25%, C: 29%, D: 33%). Age older than 68 years (P < 0.01), American Society of Anesthesiologists score of 3 or higher (P < 0.0001), benign findings on imaging (P < 0.0001), and major comorbid conditions (P < 0.01) were factors associated with higher rate of failure to compliance. On multivariate logistic regression, American Society of Anesthesiologists score of 3 or higher and benign features were associated with 4.0 times (95% confidence interval, 2.02-8.06) and 2.6 times (95% confidence interval, 1.60-4.07) higher odds of failure to compliance with guidelines, respectively.
  
  
  
  Compliance with clinical guidelines for the management of IPMN is poor. Socioeconomic factors do not seem to create a disparity to care. However, many patients with IPMN have other medical diagnoses that take priority over IPMN surveillance and treatment.
authors.affiliation: From the *Recanati-Miller Transplantation Institute; Departments of †Surgery, Division of Surgical Oncology, ‡Radiology, §Health Evidence and Policy, Center for Biostatistics, and ∥Pathology, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Parissa
authors.initials: P
authors.lastname: Tabrizian
authors.forename: Yaniv
authors.initials: Y
authors.lastname: Berger
authors.forename: Elisa Sefora
authors.initials: ES
authors.lastname: Pierobon
authors.forename: Samantha
authors.initials: S
authors.lastname: Aycart
authors.forename: Pamela
authors.initials: P
authors.lastname: Argiriadi
authors.forename: Kezhen
authors.initials: K
authors.lastname: Fei
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Carrasco-Avino
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Labow
authors.forename: Umut
authors.initials: U
authors.lastname: Sarpel
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000175:diagnosis / Q000628:therapy*; D000231:Adenocarcinoma, Papillary / Q000175:diagnosis / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000628:therapy*; D017410:Practice Guidelines as Topic