title: Multiple interventions with prolonged length of stay are required for treatment of necrotizing pancreatitis.
abstract: BACKGROUND
  A proportion of patients with acute pancreatitis (AP) develop necrosis. Around a third will become infected, and this is associated with a significant requirement for intervention and support. We evaluated the burden of necrotizing pancreatitis (NP) in an Australian tertiary hospital with regards to morbidity, mortality and resource consumption.
  
  
  METHODS
  This is a retrospective case series of patients with AP admitted for at least 5 days to identify those with NP between 2009 and 2014. Data were analysed in groups according to the determinant-based classification of AP severity.
  
  
  RESULTS
  Of 1339 patients with AP, 546 stayed 5 days or longer, and 38 had necrosis. Overall mortality for those with necrosis was 10.5% (4/38). Infection complicated necrosis in 45% (17/38). Organ failure also occurred in 45% (17/38) of patients with necrosis. All patients in the critical category and severe category required admission to the intensive care unit for a median of 21 and 12 days, respectively. A total of 90% of patients with critical category disease developed multi-organ failure, whereas most with severe category disease developed single organ failure only. Overall length of stay increased with increasing severity of disease. Intervention was required in 82% of infected necrosis (median 4 procedures). Those without infection also required multiple radiological investigations (median 7).
  
  
  CONCLUSIONS
  Necrosis is uncommon in our cohort but is associated with a significant health-care burden. Almost half the patients with necrosis develop organ failure requiring prolonged hospital and intensive care unit stay. Patients require multiple investigations and interventions for infected necrosis. NP remains a costly, morbid disease in our society.
authors.affiliation: Department of Surgery, Frankston Hospital, Peninsula Health, Melbourne, Victoria, Australia.
authors.forename: Hamish
authors.initials: H
authors.lastname: Shilton
authors.affiliation: Department of Surgery, Frankston Hospital, Peninsula Health, Melbourne, Victoria, Australia.
authors.forename: Daniel
authors.initials: D
authors.lastname: Breen
authors.affiliation: Department of Surgery, Frankston Hospital, Peninsula Health, Melbourne, Victoria, Australia.
authors.forename: Sachin
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Department of Surgery, Frankston Hospital, Peninsula Health, Melbourne, Victoria, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Evans
authors.affiliation: Department of Surgery, Frankston Hospital, Peninsula Health, Melbourne, Victoria, Australia.
authors.forename: Charles
authors.initials: C
authors.lastname: Pilgrim
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia; D003422:Critical Care; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications / Q000401:mortality / Q000628:therapy*; D000078337:Procedures and Techniques Utilization; D019233:Retreatment; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D062606:Tertiary Care Centers; D016896:Treatment Outcome
keywords: critical care; delivery of health care; pancreatitis; pancreatitis, acute necrotizing; patient care management