Changes in preoperative endoscopic and percutaneous bile drainage in patients with periampullary cancer undergoing pancreaticoduodenectomy in Ontario: effect on clinical practice of a randomized trial

摘要

Background In 2010, a multicentre randomized controlled trial reported increased postoperative complications in pancreaticoduodenectomy ( pde ) patients undergoing preoperative biliary decompression ( pbd ). We evaluated the effect of that publication on rates of? pbd ?at the population level. Methods This retrospective observational cohort study identified patients undergoing? pde ?for malignancy, 2005–2013, linking them with administrative health care databases covering medical services for a population of 13.5 million. Patients undergoing? pbd ?within 6 weeks before their surgery were identified using physician billing codes and were divided into those undergoing? pde ?before and after article publication, with a 6-month washout period. Chi-square tests were used to compare rates of? pbd . Results Of 1997? pde ?patients identified, 963 underwent surgery before article publication, and 911, after (123 during the washout period). The rate of? pbd ?was 47.5% before publication, and 41.6% after ( p ?= 0.01). The lowest? pbd ?rates occurred immediately after publication, in 2010 and 2011. Similar results were observed when the cohort was restricted to patients seen preoperatively by a gastroenterologist ( n ?= 1412). Conclusions Rates of? pbd ?have declined a small, but significant, amount after randomized trial publication. Persistence of? pbd ?might relate to suboptimal knowledge translation, the role of? pbd ?in diagnosis of periampullary malignancy, and treatment of complications (cholangitis, severe hyperbilirubinemia) or anticipation of delay from diagnosis to surgery. The nadir in? pbd ?rates after article publication and the subsequent rise suggest an element of transience in the effect of article publication on clinical practice. Further investigation into the reasons for persistent? pbd ?is needed.