Analysis of a Step-Up Approach Versus Primary Open Surgical Necrosectomy in the Management of Necrotizing Pancreatitis: Experience in a Cohort of Patients at a US Academic Medical Center. Issue 10 (November 2018)

• Record Type: Journal Article
• Authors: Jones, Jason D.; Clark, Clancy J.; Dyer, Raymond; Case, L. Douglas; Mishra, Girish; Pawa, Rishi
• Is Part Of: Pancreas. Volume 47:Issue 10(2018)
• Publication Date: 2018-11
• Subjects: necrotizing pancreatitis -- walled-off pancreatic necrosis -- step-up -- surgical necrosectomy; Pancreas -- Diseases -- Periodicals; Pancreas -- Periodicals; Neuroendocrine tumors -- Periodicals; 616.37005
• DOI: 10.1097/MPA.0000000000001154
• Languages: English
• ISSNs: 0885-3177

Abstract

Abstract : Objectives: An increasing number of providers have begun to use a minimally invasive step-up approach as opposed to traditional surgical necrosectomy in the management of acute necrotizing pancreatitis. Studies have shown mixed results, thus we hypothesized that the step-up approach is safer and associated with decreased mortality and length of stay (LOS). Methods: This is a retrospective cohort study of patients admitted from January 2010 to March 2015 who underwent interventions for walled-off pancreatic necrosis (WOPN). Primary outcomes included LOS after intervention and mortality, in-hospital and 90-day, with secondary outcomes of procedural complications. Results: Sixty-nine patients developed WOPN requiring intervention during the study period. In-hospital mortality was 5.6% (n = 2) in the step-up cohort compared with 18.2% (n = 6) in the surgical cohort (relative risk, 3.27; 95% confidence interval, 0.71–15.09). Ninety-day mortality was 9.1% (n = 3) in the step-up cohort and 21.9% (n = 7) in the surgical cohort (relative risk, 2.41; 95% confidence interval, 0.68–8.50). Postintervention LOS was 8 days in the step-up cohort and 17 days in the surgical cohort ( P = 0.62). Conclusions: A step-up approach, as compared with primary surgical necrosectomy in the management of WOPN, results in clinically significant decreases in mortality and LOS.