Are Clinical Guidelines for the Management of Intraductal Papillary Mucinous Neoplasms Followed?: A Single-Center Analysis.

OBJECTIVES

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.