A contemporary series of patients undergoing open debridement for necrotizing pancreatitis.
BACKGROUND
For patients with acute pancreatitis complicated by infected necrosis, minimally invasive techniques have taken hold without substantial comparison with open surgery. We present a contemporary series of open necrosectomies as a benchmark for newer techniques.


METHODS
Using a prospective database, we retrospectively identified consecutive patients undergoing debridement for necrotizing pancreatitis (2006 to 2009). The primary endpoint was in-hospital mortality.


RESULTS
Sixty-eight patients underwent debridement for pancreatic/peripancreatic necrosis. In-hospital mortality was 8.8% (n = 6). Infection (n = 43, 63%) and failure-to-thrive (n = 13, 19%) comprised the most common indications for necrosectomy. The false negative rate (FNR) for infection of percutaneous aspirate was 20.0%. Older age (P = .02), Acute Physiology and Chronic Health Evaluation II score upon admission (P = .03) or preoperatively (P < .01), preoperative intensive care unit admission (P = .01), and postoperative organ failure (P = .03) were associated with mortality.


CONCLUSIONS
Open debridement for necrotizing pancreatitis results in a low mortality, providing a useful comparator for other interventions. Given the high FNR of percutaneous aspirate, debridement should not be predicated on proven infection.
Department of Surgery, Division of Trauma Emergency Surgery and Critical Care, Boston, MA 02114, USA.
Arin L
AL
Madenci
Department of Surgery, Division of Trauma Emergency Surgery and Critical Care, Boston, MA 02114, USA.
Maria
M
Michailidou
Department of Surgery, Division of Trauma Emergency Surgery and Critical Care, Boston, MA 02114, USA.
Grace
G
Chiou
Department of Radiology, Massachusetts General Hospital, 165 Cambridge Street, Boston, MA 02114, USA.
Ashraf
A
Thabet
Department of Surgery, Division of Trauma Emergency Surgery and Critical Care, Boston, MA 02114, USA.
Carlos
C
Fernández-del Castillo
Department of Surgery, Division of Trauma Emergency Surgery and Critical Care, Boston, MA 02114, USA. Electronic address: pfagenholz@partners.org.
Peter J
PJ
Fagenholz
D003646:Debridement / Q000379:methods*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
Acute necrotizing pancreatitis; Debridement; Minimally invasive surgical procedures; Pancreatic diseases; Sensitivity and specificity