title: Proactive Versus Standard Percutaneous Catheter Drainage for Infected Necrotizing Pancreatitis.
abstract: Percutaneous catheter drainage (PCD) is often the first invasive treatment step for infected necrotizing pancreatitis. A proactive PCD strategy, including frequent and early drain revising and upsizing, may reduce the need for surgical necrosectomy and could improve outcomes, but data are lacking.
  
  
  
  Necrotizing pancreatitis patients were identified from in-hospital databases (2004-2014). Patients with primary PCD for infected necrotizing pancreatitis were included. Outcomes of patients from 1 center using a proactive PCD strategy were compared with 3 standard strategy centers.
  
  
  
  In total, 369 (25.9%) of 1427 patients received a diagnosis of necrotizing pancreatitis, and 117 (31.7%) of 369 patients underwent primary PCD for infected necrosis: 42 in the proactive group versus 75 in the standard group. Patients in the proactive group had more drain-related procedures (median, 3; interquartile range [IQR], 2-4; versus 2; IQR, 1-2; P < 0.001) and larger final drain sizes (median, 16F; IQR, 14F-20F; versus 14F; IQR, 12F-14F; P < 0.001). Fewer patients underwent additional necrosectomy in the proactive group, 12 (28.6%) versus 39 (52.0%) (adjusted odds ratio, 0.349; 95% confidence interval, 0.137-0.889; P = 0.027), with similar hospital stay and mortality.
  
  
  
  A proactive PCD strategy is associated with reduced need for necrosectomy in infected necrotizing pancreatitis, compared with standard PCD, with similar clinical outcomes.
authors.affiliation: From the *Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam; †Department of Surgery, St Antonius Hospital, Nieuwegein; ‡Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen; §Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam; ∥Department of Surgery, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam; and ¶Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Janneke
authors.initials: J
authors.lastname: van Grinsven
authors.forename: Pieter
authors.initials: P
authors.lastname: Timmerman
authors.forename: Krijn P
authors.initials: KP
authors.lastname: van Lienden
authors.forename: Jan Willem
authors.initials: JW
authors.lastname: Haveman
authors.forename: Djamila
authors.initials: D
authors.lastname: Boerma
authors.forename: Casper H J
authors.initials: CH
authors.lastname: van Eijck
authors.forename: Paul
authors.initials: P
authors.lastname: Fockens
authors.forename: Hjalmar C
authors.initials: HC
authors.lastname: van Santvoort
authors.forename: Marja A
authors.initials: MA
authors.lastname: Boermeester
authors.forename: Marc G
authors.initials: MG
authors.lastname: Besselink
mesh_terms: D000328:Adult; D000368:Aged; D057785:Catheters; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019283:Pancreatitis, Acute Necrotizing / Q000628:therapy*; D012044:Regression Analysis; D012189:Retrospective Studies; D016896:Treatment Outcome