Analysis of a Step-Up Approach Versus Primary Open Surgical Necrosectomy in the Management of Necrotizing Pancreatitis
| Autor: | Jason D. Jones, Raymond B. Dyer, Rishi Pawa, L. Douglas Case, Clancy J. Clark, Girish Mishra |
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| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
Hepatology business.industry Endocrinology Diabetes and Metabolism Psychological intervention MEDLINE Retrospective cohort study medicine.disease Confidence interval 03 medical and health sciences 0302 clinical medicine Endocrinology 030220 oncology & carcinogenesis Internal medicine Relative risk Cohort Internal Medicine medicine Pancreatitis 030211 gastroenterology & hepatology Necrotizing pancreatitis business |
| Zdroj: | Pancreas. 47:1317-1321 |
| ISSN: | 1536-4828 0885-3177 |
| Popis: | Objectives An increasing number of providers have begun to use a minimally invasive step-up approach as opposed to traditional surgical necrosectomy in the management of acute necrotizing pancreatitis. Studies have shown mixed results, thus we hypothesized that the step-up approach is safer and associated with decreased mortality and length of stay (LOS). Methods This is a retrospective cohort study of patients admitted from January 2010 to March 2015 who underwent interventions for walled-off pancreatic necrosis (WOPN). Primary outcomes included LOS after intervention and mortality, in-hospital and 90-day, with secondary outcomes of procedural complications. Results Sixty-nine patients developed WOPN requiring intervention during the study period. In-hospital mortality was 5.6% (n = 2) in the step-up cohort compared with 18.2% (n = 6) in the surgical cohort (relative risk, 3.27; 95% confidence interval, 0.71-15.09). Ninety-day mortality was 9.1% (n = 3) in the step-up cohort and 21.9% (n = 7) in the surgical cohort (relative risk, 2.41; 95% confidence interval, 0.68-8.50). Postintervention LOS was 8 days in the step-up cohort and 17 days in the surgical cohort (P = 0.62). Conclusions A step-up approach, as compared with primary surgical necrosectomy in the management of WOPN, results in clinically significant decreases in mortality and LOS. |
| Databáze: | OpenAIRE |
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