SEARCHCOHORTsurgery, critical care

cohort·surgery, critical care, gastroenterology, internal medicine, observational study·PMC1065077

Perioperative factors determine outcome after surgery for severe acute pancreatitis

Critical Care · 9 authors, 4 centres

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TL;DR

This retrospective cohort study of 56 ICU patients undergoing surgery for severe acute pancreatitis found that age, organ dysfunction at the moment of surgery, and sterile necrosis—not timing of surgery—were independently associated with mortality.

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This retrospective cohort study analyzed 56 of 124 ICU patients with severe acute pancreatitis who underwent surgery between January 1994 and March 2003. Overall mortality was 39.2%. In univariate analysis, non-survivors were older, had higher APACHE II scores on admission, higher SOFA scores at the day of surgery, more often had sterile necrosis, and more often had organ dysfunction.

STUDY TYPE

cohort

SPECIALTY

surgery

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AI pipeline

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100% · A

ORIGINAL PAPER

PMC1065077

Perioperative factors determine outcome after surgery for severe acute pancreatitis

Critical Care

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ABSTRACT

Abstract Introduction There is evidence that postponing surgery in critically ill patients with severe acute pancreatitis (SAP) leads to improved survival, but previous reports included patients with both sterile and infected pancreatic necrosis who were operated on for various indications and with different degrees of organ dysfunction at the moment of surgery, which might be an important bias. The objective of this study is to analyze the impact of timing of surgery and perioperative factors (severity of organ dysfunction and microbiological status of the necrosis) on mortality in intensive care unit (ICU) patients undergoing surgery for SAP. Methods We retrospectively (January 1994 to March 2003) analyzed patients admitted to the ICU with SAP. Of 124 patients, 56 were treated surgically; these are the subject of this analysis. We recorded demographic characteristics and predictors of mortality at admission, timing of and indications for surgery, and outcome. We also studied the microbiological status of the necrosis and organ dysfunction at the moment of surgery. Results Patients' characteristics were comparable in patients undergoing early and late surgery, and there was a trend toward a higher mortality in patients who underwent early surgery (55% versus 29%, P = 0.06). In univariate analysis, patients who died were older, had higher organ dysfunction scores at the day of surgery, and had sterile necrosis more often; there was a trend toward earlier surgery in these patients. Logistic regression analysis showed that only age, organ dysfunction at the moment of surgery, and the presence of sterile necrosis were independent predictors of mortality. Conclusions In this cohort of critically ill patients operated on for SAP, there was a trend toward higher mortality in patients operated on early in the course of the disease, but in multivariate analysis, only greater age, severity of organ dysfunction at the moment of surgery, and the presence of sterile necrosis, but not the timing of the surgical intervention, were independently associated with an increased risk for mortality. Keywords: acute necrotizing pancreatitis, infected pancreatic necrosis, multiple organ failure, severe acute pancreatitis

CITATION EXPORT

Jan J De Waele, Eric Hoste, Stijn I Blot et al.. Perioperative factors determine outcome after surgery for severe acute pancreatitis. Critical Care. (2004). https://doi.org/10.1186/cc2991

AUTHORS

9 · 4 CENTRES

Jan J De Waele, Eric Hoste, Stijn I Blot, Uwe Hesse, Piet Pattyn, Bernard de Hemptinne, Johan Decruyenaere, Dirk Vogelaers, Francis Colardyn

1Intensivist, Intensive Care Unit, Ghent University Hospital, Gent, Belgium
2Researcher, Intensive Care Unit, Ghent University Hospital, Gent, Belgium
3Surgeon, Intensive Care Unit, Ghent University Hospital, Gent, Belgium
4Infectious Diseases Consultant, Department of Surgery, Ghent University Hospital, Gent, Belgium