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Letters pancreatic fistula mitigation, and we chose not to include the researchers for contributing to a new and growing body of these patients in the HYPAR trial. This decision inevitably research regarding hair and arm covering in the perioperative led to increased rates of pancreatic fistula. The RCT assess- setting. There have been several changes to the 2019 Guide- ing hydrocortisone used histological assessment of the pan- line for Surgical Attire, including recommendations regard- creatic resection margin to stratify patients into the high-risk ing hair and arm covering, laundering practices, personal items, category. The method has not been externally validated. We shoes, and cover apparel. used the most common method, assessment of the firmness The AORN Guidelines are authored by perioperative nurs- of the pancreas and diameter of the pancreatic duct. These ing specialists and selected members of the AORN Guidelines differences in categorizing patients into high risk might lead Advisory Board in collaboration with liaisons from the Ameri- to different populations and could affect the observed fistula can Association of Nurse Anesthetists, the American College rates. We thank the commenters for these insightful views, of Surgeons, the American Society of Anesthesiologists, the and we agree that the jury
JAMA Surgery – American Medical Association
Published: Oct 22, 2020
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