Inconsistent practice demonstrates need for clear guidance on the use of octreotide for pancreatic leaks

Background

A pancreatic leak is one of the most common complications of pancreatic surgery. Octreotide is the main pharmacological agent for the prophylaxis or treatment (unlicensed) of pancreatic leaks. It is a somatostatin analogue that works by reducing pancreatic secretions which in turn reduces the volume of fluid available to leak out. Currently, there are no guidelines on the use of octreotide, which leads to significant variation in the way it is being used for different patients.

Objectives

The aim of this audit was to provide a starting point for the creation of a local guideline for the use of octreotide. The standards for the audit were set with the objective of gathering information about how octreotide is currently being used in practice at the Royal Free Hospital (RFH).

Methods

JAC was used to compile a list of patients who were dispensed octreotide from April to October 2023 allocated to a hepato-pancreato-biliary consultant. From this list, 30 patients were chosen at random to be included in the data collection and the electronic patient records were used to gather the data.

The key areas of data collection were identifying the most common dose and frequency of octreotide, identifying whether drain fluid amylase (DFA) was measured on days one, three and five, and identifying if octreotide was discontinued when DFA was normalised, total drain output was ≤ 25 mL and/or oral intake was restarted.

Results

The analysis identified that 200 mcg three times a day by subcutaneous injection was the most prescribed dose and frequency, both for prophylaxis and treatment of pancreatic leak. Only three patients had their DFA levels measured on the correct days (one, three, five) with eight patients having no level measured at all. Additionally, nine patients were continued on octreotide until discharge despite five of these patients having their drain removed up to four days earlier and two patients who had normalised DFA levels two days before octreotide was stopped. Seventeen patients were encouraged to have oral intake whilst still using octreotide.

Conclusions

This audit identified a clear lack of consistency over the way octreotide is being used at RFH for the management of post-operative pancreatic leaks. Measuring of DFA levels tended to be erratic and patients were continuing octreotide for longer than seemingly necessary. Limitations of this audit included being unable to identify patients who received octreotide dispensed to the wrong cost centre. Additionally, time constraints meant some information may have been missed when reading documentation. The key recommendation is that there is an urgent need for the creation of a guideline for prescribing of octreotide to improve the standard of patient care.

Additional authors: A. Jonroy & T. Randhawa

The opinions expressed in this article are those of the author. They do not purport to reflect the opinions or views of the UKCPA or its members. We encourage readers to follow links and references to primary research papers and guidance.

Competing interest statement:

The author declares: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.