A Ten Year Cross Sectional Multicentre Study of Infected Pancreatic Necrosis, Trends in Management and an Analysis of Factors Predicting Mortality for Interventions in Infected Pancreatic Necrosis

Objective To identify trends in management and analyse outcomes of patients undergoing interventions for infected pancreatic necrosis with specific reference to factors predictive of mortality. Method A cross sectional study of patients undergoing intervention for IPN between 2009-2018 were performed at two of the largest hepatopancreatobiliary centres in Malaysia. Final outcome measure of complete resolution was compared against mortality (D). Head to head comparison of percutaneous catheter drainage alone versus Videoscopic Assisted Retroperitoneal Debridement was performed based on final predictive factor on mortality. Results A total number of 65 patients with IPN were identified. Data from 59/65 patients were analysed for final outcome of death (D) versus complete resolution. 6 patients were omitted due to incomplete data precluding proper analysis. Overall mortality rate was 25% (15/59 patients). 8 patients had no interventions performed but were included in the analysis. Percutaneous catheter drainage alone and Videoscopic Assisted Retroperitoneal Debridement were the 2 commonest interventions performed (34/55). Multivariable analysis predictive of mortality included persistent organ failure requiring intensive care unit (ICU) admission (OR= 336.425, CI 95% =3.722-999.999 p value= 0.0113) and when PCD alone was employed compared to VARD (OR = 48.923, CI 95% = 1.888-999.999, p-value = 0.019). Conclusion Our present study shows that both persistent organ failure requiring ICU admission and Percutaneous Catheter Drainage alone when compared to a minimally invasive step up approach (in the form of Video assisted Retroperitoneal Debridement) are predictive factors of mortality in patients undergoing intervention for IPN. A step up approach is necessary to prevent mortality in patients with infected pancreatic necrosis requiring intervention while PCD without debridement results in significant mortality.

Author(s): Johann Faizal Khan, Suryati Mokhtar, Krishnan Raman, Harjit Singh, Leow Voon Meng, Manisekar K Subramaniam

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