ARE TRADITIONAL PROGNOSTIC CRITERIA USEFUL IN PANCREATIC-ABSCESS

Pancreatic abscess remains a potentially lethal disease. Efforts to re late outcome to the severity of associated pancreatitis or the type of surgical drainage employed have yielded conflicting results. This stu dy was designed to test the validity of traditional prognostic criteri a in the clinical setting of pancreatic abscess and to determine wheth er the technique of surgical drainage employed correlated with surviva l. The records of 40 consecutive patients with pancreatic abscess were reviewed. In each case the diagnosis was confirmed by operation. Prog nostic factors analyzed included number of Ranson criteria, etiology, type, and number of microorganisms isolated, extent of abscess, time t o diagnosis and operation, and technique of surgical drainage. Of the 11 Ranson criteria evaluated, only an elevation in blood urea nitrogen >5 mg/dl correlated with decreased survival (p < 0.001). Polymicrobia l abscesses (three or more organisms) resulted in a higher mortality t han abscesses where fewer than three organisms were isolated (45.4 vs 13.8%; p < 0.05). Intraperitoneal extension of the abscess was associa ted with an increased mortality rate compared to those confined to the retroperitoneum (57.1 vs 15.2%; p < 0.01). In patients requiring unpl anned reexploration, mortality was significantly increased (42.9 vs 11 .5%; p < 0.05). The technique of surgical drainage employed (open vers us closed) did not influence overall mortality (23.5 vs 21.7%; p = NS) . Extent of disease at operation, polymicrobial abscess, reexploration for persistent or recurrent disease, and deterioration in renal funct ion were all predictive of increased mortality in cases of pancreatic abscess. Traditional Ranson criteria were not useful predictors of sur vival. No correlation existed between type of surgical drainage employ ed and subsequent outcome.