Timing of intervention in necrotizing pancreatitis

The best available evidence suggests that surgical intervention should be delayed where possible until four weeks after the onset of pancreatitis. Subgroups that may benefit from early or delayed intervention have not been identified.

This study reviewed a prospective database with 223 patients of necrotizing pancreatitis who received intervention. A subgroup analysis was performed to compare the results of different surgical timing.

The median timing of intervention was 32 days. The mortality rates in the early (≤30 days) intervention and delayed intervention (>30 days) groups were 21% (28/136) and 10% (9/87), respectively (P = 0.04). In patients with persistent early organ failure, mortality and re-intervention rates were higher in the early group compared with the delayed group (23/61 vs. 3/21, P = 0.04; 17/61 vs. 2/21, P = 0.01). In patients without persistent early organ failure who underwent treatment, mortality rates, and re-intervention rates were similar between the early group and delayed group (5/75 vs. 6/66, P = 0.59; 7/75 vs. 3/66, P = 0.27). In patients with infected necrosis, mortality rate was similar with the early group and delayed group (17/77 vs. 7/57, P = 0.14).

Early intervention in patients without persistent organ failure showed similar outcomes with patients who received delayed intervention.