Decreased mortality from necrotizing pancreatitis

BACKGROUND: Necrotizing pancreatitis has been associated with mortality rat es of 25% to 80%. We reviewed our experience to determine whether aggressiv e debridement and comprehensive critical care improves survival. METHODS: The records of 989 patients with the diagnosis of pancreatitis adm itted between January 1990 and September 1997 were retrospectively reviewed . Twenty-six patients required surgery for necrotizing pancreatitis and are the subjects of this review. RESULTS: Five of twenty-six patients (19%) died. For all patients, mean Ran son's score was 4.3 of 11, mean admission APACHE II score was 17.2, and mea n Multiple Organ Dysfunction (MOD) score was 9.1. Poor outcome was associat ed with infected pancreatic necrosis (P = 0.03), elevated APACHE II score o n admission (P = 0.04), and progression of MOD during the week after admiss ion (P = 0.02). CONCLUSIONS: This review demonstrates improved survival in seriously ill pa tients with necrotizing pancreatitis as a result of comprehensive surgical and critical care. Am J Surg. 1998;176:648-653, (C) 1998 by Excerpta Medica , Inc.