LONG-TERM OUTCOME AFTER OPEN TREATMENT OF SEVERE INTRAABDOMINAL INFECTION AND PANCREATIC NECROSIS

Background: Outcome assessment after surgical treatment of intra-abdom inal infections and pancreatic necrosis has concentrated on postoperat ive complications and survival, while long-term results have received little attention. Objectives: To evaluate hospital costs and long-term outcome for patients undergoing open treatment of intra-abdominal inf ection or pancreatic necrosis and to determine whether results justify costs. Design: Cohort study and cost-effectiveness analysis. Setting: Referral center. Patients: From January 1, 1988, through June 30, 199 6, we used open treatment for 147 patients with pancreatic necrosis (n = 75; group 1), severe intra-abdominal infections due to benign disea ses (n = 50; group 2), and infections due to malignant neoplasm (n = 2 2; group 3). All surviving patients (n = 92) were followed up. Fifty-s even patients in group 1, 25 patients in group 2, and 10 patients in g roup 3 survived. Interventions: The effective costs of treatment per s urviving patient (including restorative surgery) were calculated. The patients were interviewed, and the residence location. medical treatme nt, degree of recovery, functional state, and employment status were a ssessed. We assessed the quality of life by using the short general he alth survey (SF-36). Main Outcome Measures: Costs, survival, and longt erm outcome. Results: The effective costs per survivor studied were $ 175 000 (group 1) and $ 23 2 400 (groups 2 and 3). Most patients exper ienced good long-term results, ie, employment status was unchanged for 69 (75 %) of the patients, and the functional state was unchanged for 81 (88 %) of the patients. Readmission to a hospital was necessary fo r 14 (15 %) of the patients, and 5 (6 %) required care in nursing home s. Of the patients studied, 75 % described their quality of life as go od. Patients in group 3 had significantly worse results for survival, functional status, and quality of life (P < .01, log-rank test). Concl usions: Our study demonstrated that open treatment of severe intra-abd ominal infection and pancreatic necrosis is a cost-effective treatment with good longterm results for most patients. However, patients with malignant neoplasms did not benefit from this therapy and, therefore, should not be treated by laparostomy.