Outcome of necrosectomy in acute XXXX : the case for continued vigilance.

@entity1 @entity788 @entity204 @entity39
BACKGROUND: Surgery for pancreatic @entity39 complicating acute severe @entity788 carries a high risk of mortality and may be influenced by a range of variables including patterns of referral, case selection and quality of care. METHODS: An observational study of a consecutive series of 54 @entity1 undergoing pancreatic necrosectomy in a specialist Hepatobiliary unit over an 8-year study period. Principal outcomes were organ dysfunction and physiological derangement in relation to surgery, microbial colonization of @entity39 and relation to outcome, re-operation rates, requirement for peri-operative nutritional support, trends in mortality and survival analysis. RESULTS: Necrosectomy was associated with statistically significant deterioration in immediate postoperative organ dysfunction scores (ANOVA P < 0.01). Infected @entity39 was present in 36 (68%). Fungal colonization of @entity39 was present in 5 (9%). Mortality in this subgroup was 80% (4 deaths). There was no association between bacterial colonization of @entity39 and @entity204 in this study (P = 0.77; Fisher exact test; relative risk 0.9,95% confidence interval 0.54-1.54). Twenty @entity1 (37%) required further surgical intervention with an average of 1.5 surgical procedures per @entity1 . Twenty-three @entity1 (43%) died. @entity1 survival to discharge was best predicted by admission APACHE-II score with relative risk of @entity204 increasing 14% for each unit increase in APACHE-II score at admission. CONCLUSIONS: The results of the present study illustrate that there is no place for complacency in the surgical management of @entity1 with severe acute @entity788 . A clinical governance approach would promote pre-defined protocols between admitting hospitals and tertiary referral centres. Future research should target new interventions in @entity1 with high admission APACHE-II scores in whom prognosis is particularly poor and explore the role of infection of @entity39 tissue.
