title: Surgical treatment for severe acute pancreatitis: extent and surgical control of necrosis determine outcome.
abstract: In patients operated on for severe acute pancreatitis (SAP), the factors determining outcome remain unclear. From 1986 to 1998 a total of 340 patients with a diagnosis of SAP and in need of operative treatment were admitted to the intensive care unit (ICU) of a university hospital and a secondary care hospital. The mean APACHE II score on the day of admission was 16.1 (range 8-35). All patients required operative therapy. Among the 340 patients, 270 (79.4%) had to be reoperated: 196 patients (72.6%) underwent operative revisions on demand, and 74 (27.4%) patients had preplanned reoperation. The overall mortality was 39.1% (133 patients). Septic organ failure in 126 patients (37.1%) and myocardial infarction or pulmonary embolism in 7 patients (2%) were the causes of death. The patient's age (p < 0.0002), APACHE II scores at admission (p < 0.0001), presence or development of (single or multiple) organ failure (p < 0.002), infection (p < 0.02) and extent (p < 0.04) of pancreatic necrosis, and surgical control of local necrosis (p < 0.0001) significantly determined survival. SAP that requires surgical treatment is associated with high in-hospital mortality. Surgical control of local necrosis is the precondition for survival. Advanced age of the patient, high APACHE II score at admission, development of organ failure, and the extent and infection of pancreatic necrosis influence the outcome.
authors.affiliation: Department of General Surgery, University of Vienna, AKH, Waehringer Guertel 18-20, 1090 Vienna, Austria. peter.goetzinger@akh-wien.ac.at
authors.forename: Peter
authors.initials: P
authors.lastname: Götzinger
authors.forename: Thomas
authors.initials: T
authors.lastname: Sautner
authors.forename: Stephan
authors.initials: S
authors.lastname: Kriwanek
authors.forename: Philipp
authors.initials: P
authors.lastname: Beckerhinn
authors.forename: Murat
authors.initials: M
authors.lastname: Barlan
authors.forename: Christian
authors.initials: C
authors.lastname: Armbruster
authors.forename: Peter
authors.initials: P
authors.lastname: Wamser
authors.forename: Reinhold
authors.initials: R
authors.lastname: Függer
mesh_terms: D018806:APACHE; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000401:mortality; D009336:Necrosis; D010179:Pancreas / Q000473:pathology; D010195:Pancreatitis / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome