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PPS49. Evidence-Based Paradigm for Intraoperative Carcinoid Crisis Management - A Single center experience with over 500 surgical cases

Friday, March 6, 2026
3:40 PM - 4:10 PM MST
Location: HUB Poster Park - West Hall 1-3
Introduction: To evaluate the efficacy of implementing an evidence-based carcinoid crisis management protocol (CCMP), on operative and clinical outcomes in patients undergoing abdominal surgery for gastroenteropancreatic neuroendocrine tumors (GEPNET). 


Methods: A retrospective cohort study was performed in consecutive patients having abdominal surgery for GEPNET at a single institution (2015-2024). CC was defined as a sudden drop in SBP >20mmHg, unexplained by other intraoperative events, and agreed upon by the operating surgeon and anesthesiologist. A CCMP was developed and implemented as a component of the surgical time-out process: no octreotide prophylaxis, early CC recognition, and treatment of hypotension using a standardized medication bundle. Implementation occurred during a 3-month period (Oct-Dec 2020). Comparative analyses were performed between the standard-SA (July 2015–Sept 2020) and the intervention-CCMP (Jan 2021- Oct 2024). The primary outcome was intraoperative cumulative duration of CC events. Secondary outcomes included postoperative clinical outcomes and process measures of intraoperative management.


Results: A total of 506 cases were identified (321 SA, 185 CCMP).  Overall, there were no differences between groups in clinical and tumor variables, though ASA score and the proportion of patients with liver metastasis were higher in the CCMP group (p< 0.05). Compliance of CCMP implementation was 96%. The incidence of CC did not vary by group (14% SA vs. 16% CCMP; p=0.6). The median intraoperative cumulative duration of CC was significantly longer in the SA (15min [5-60]) vs. the CCMP (10min [1-34]) group (p=0.001). Further, significant differences were noted in median intraoperative fluid volume administration (SA=1,800cc vs CCMP=1,400; p< 0.001), and median length of stay (LOS) (SA=6.0 days vs. CCMP=5.0 days; p< 0.001). Multivariate models with quantile regression and sensitivity analysis with linear models for the primary outcome revealed a significant shorter cumulative duration of CC with CCMP implementation (p< 0.05, all models).


Conclusions:

Implementation of a carcinoid crisis management protocol into the surgical time-out process, which omits octreotide prophylaxis, and centers on early CC recognition with systematic and standardized treatment of hypotension is effective in reducing the cumulative duration of CC and improved outcomes. We propose a revision to national guidelines, driven by available evidence, that shifts away from routine octreotide prophylaxis for patients undergoing abdominal surgery for GEPNETs.

Learning Objectives:

  • Does the use of prophylactic octreotide decrease the incidence of carcinoid crisis?
  • List three benefits of a no prophylaxis and instead an intra-operative carcinoid crisis management protocol.
  • Did implementation of a carcinoid crisis protocol decrease total length of stay?