Clinical Practice Guideline in Complicated Intraabdominal Infection 2018 An Indonesian Perspective

Author(s):
Diane Catalano; Toar Lalisang

Background:

The prevalence of cIAi represent by data from six tertiary hospitals in Indonesia in mid–2017 were ranged in 10% with mortality 16.6%.%. The heterogeneity of management was thought to be responsible to such number even though there were CPGs on cIAI that periodically updated. Further it is realized that there was a problem in the implementation of these guidelines due to different characteristics found. Therefore, an Indonesian specific guideline should be developed.

Methods:

The team assigned by Indonesian association of digestive surgeons (IKABDI) started to develop a guideline by process of adaptation which is consist of three steps in accordance to ADAPTE. Critical appraisal of CPGs was preceded using AGREE II Tools. Where as CheckUp was used for those updated CPGs. On the development, a provided tool online for CPG development namely GRADEPro GDT available in GRADE was used. The statements and recommendation were setup by Delphi method. Reviews were carried out internal and externally by CEEBM of Faculty of Medicine Universitas Indonesia, dr Cipto Mangunkusumo General Hospital.

Results:

Seven questions formulated in the setup phase. On searching, there were 68 guidelines with full text downloaded from several sites. On selection, there were 33 CPGs related to intraabdominal infection and 18 among others were specific CPG on IAIs and cIAIs. Furthers, the last mentioned eighteen CPGs were appraised using AGREE II tools and found that 13 CPGs were strong recommended, 3 were of can be recommended, and 2 of not recommended. The next step was the evaluation of the updated CPGs using CheckUp. On the evaluation there were five updated CPGs, and those five earned the same score. It found two CPGs of ‘strong recommended’, updated, and recently published in 2017. The answer for clinical questions asked in the early step of the development is then searched on these two selected CPGs, with consideration to Indonesian specific characteristic. The draft was reviewed by each member through electronic communication. Appropriate statements and recommendations were then adapted. There were 153 statements and recommendations established by the hierarchy of evidence used by Guyatt et all on GRADE with regards on the changes of the descriptor (2012 and 2016), appropriateness to Indonesian specific characteristics, benefit and risk, and cost.

Conclusions:

The need of Indonesian specific CPGs is absolute, to equate perception of IAI/cIAI and the management, but not to eradicate heterogeneity in management.