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Complications after surgery for necrotising pancreatitis: risk factors and prognosis
S Kriwanek1, M Gschwantler, P Beckerhinn
1Department of Surgery, Rudolfstiftung Hospital, Vienna, Austria.
Objective:
To evaluate risk factors, results of treatment, and prognostic influence of complications on survival from acute necrotising pancreatitis.
Design:
Retrospective study of prospectively collected data.
Setting:
Tertiary referral centre, Austria.
Subjects:
100 consecutive patients operated on for necrotising pancreatitis confirmed by dynamic angio-computed tomography from 1988-1997.
Interventions:
77 patients were operated on acutely followed by open management, and in 23 the operations were delayed.
Main Outcome Measures:
Morbidity, mortality, factors predisposing to complications, prognostic effect of complications on survival.
Results:
Acute operations, alcoholic origin, APACHE II scores of > or = 10 on admission, and organ dysfunction on admission were independent factors that predisposed patients to complications. Colonic necrosis (n = 17) bleeding (n = 12) and intestinal fistulisation (n = 10) predominated. The overall mortality of complicated pancreatic necrosis was higher among patients admitted with surgical complications than in those who were not, but not significantly so (12/33 compared with 7/44 p = 0.06). Colonic necrosis (mortality 53%, relative risk: 2.45, p = 0.01), however, seemed to be of prognostic relevance.
Conclusions:
Complications are common in severe necrotising pancreatitis leading to organ dysfunction and need for acute operations. Colonic necrosis is an independent prognostic factor for survival.