Complications after surgery for necrotising pancreatitis: Risk factors andprognosis

Objective: To evaluate risk factors, results of treatment, and prognostic i nfluence of complications on survival from acute necrotising pancreatitis. Design: Retrospective study of prospectively collected data. Setting. Tertiary referral centre, Austria. Subjects: 100 consecutive patients operated on for necrotising pancreatitis confirmed by dynamic angio - computed tomography from 1988-1997. Interventions: 77 patients were operated on acutely followed by open manage ment, and in 23 the operations were delayed. Main outcome measures: Morbidity. mortality, factors predisposing to compli cations, prognostic effect of complications on survival. Results: Acute operations, alcoholic origin, APACHE LI scores of greater th an or equal to 10 on admission, and organ dysfunction on admission were ind ependent factors that predisposed patients to complications. Colonic necros is (n = 17) bleeding (n = 12) and intestinal fistulisation (n = 10) predomi nated. The overall mortality of complicated pancreatic necrosis was higher among patients admitted with surgical complications than in those who were not. but not significantly so (12/33 compared with 7/44 p = 0.06). Colonic necrosis (mortality 53%, relative risk: 2.45, p = 0.01), however, seemed to be of prognostic relevance. Conclusions: Complications are common in severe necrotising pancreatitis le ading to organ dysfunction and need for acute operations. Colonic necrosis is an independent prognostic factor for survival.