Declining morbidity and mortality rates in the surgical management of pancreatic necrosis

Thomas J. Howard, Jay B. Patel, Nicholas Zyromski, Kumar Sandrasegaran, Jian Yu, Atilla Nakeeb, Henry A. Pitt, Keith D. Lillemoe

Research output: Contribution to journalArticle

83 Scopus citations

Abstract

Surgical management of patients with pancreatic necrosis (PN) has evolved over the last two decades to include prophylactic antibiotics, initial medical management, and delayed surgical intervention. The purpose of this study is to identify changes in morbidity and mortality rates as our methods of surgical management have evolved. One hundred two consecutive patients (59 males and 43 females, mean age 53∈±∈16 years) with PN managed surgically were classified as group I (1993-2001), after the routine use of prophylactic antibiotics (N∈=∈55), and group II (2002-2005), after the use of International Association of Pancreatology (IAP) guidelines for intervention (N∈=∈47). Age, sex, etiology of pancreatitis, percent of necrosis, infected necrosis, and acute physiology and chronic health evaluation II scores were similar between groups. Despite a significant worsening of Balthazar computed tomography scoring in group II patients (p∈<∈0.0001), operative morbidity (49 [89%] vs 34 [72%], p∈=∈0.03), mortality (10 [18%] vs 2 [4%], p∈=∈0.03), and hospital length of stay (38∈±∈33 days vs 26∈±∈23 days, p∈=∈0.04) were significantly less in group II patients. Current methods of surgical management utilizing IAP guidelines have resulted in a decreased operative morbidity, mortality, and hospital length of stay in patients with PN.

Original languageEnglish (US)
Pages (from-to)43-49
Number of pages7
JournalJournal of Gastrointestinal Surgery
Volume11
Issue number1
DOIs
StatePublished - Jan 1 2007

Keywords

  • Morbidity
  • Mortality
  • Pancreatic debridement
  • Pancreatic fistula
  • Pancreatic necrosis
  • Severe acute pancreatitis

ASJC Scopus subject areas

  • Surgery

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