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ACS: Early Debridement in Acute Necrotizing Pancreatitis Associated with Increased Mortality, Morbidity By Peggy Peck Special to DG News NEW OREANS, LA -- October 11, 2001 -- Early debridement in acute necrotizing pancreatitis - within the first two weeks after presentation - is associated with a worse outcome than delayed debridement. Dr. Eric Hungness of the University of Cincinnati, Cincinnati, Ohio, United States presented the findings of his retrospective study at the 87th Clinical Congress of the American College of Surgeons. Over a seven-year period from January 1993 to June 2000, 1,775 patients were treated for acute pancreatitis at the University of Cincinnati Medical Center. Twenty-six of these patients developed acute necrotizing pancreatitis. The average age of patients in this subset was 52 and 18 were male. "These were severely ill patients as evidenced by average Ranson’s criteria of 4.8, APACHE II score of 11.7, and MOF of 4.2," he said. The average length of stay (LOS) was 70 days and the average ICU LOS was 45 days. The most common etiologies were alcohol abuse and gallstone disease, which combined accounted for 70 percent of cases. Twenty-five of the patients underwent surgical debridement, while one was managed medically. Fourteen patients underwent early debridement, meaning less than 14 days after initial presentation. All surgical debridements, early and late, consisted of open drainage with packing and planned re-operations until all the necrotic tissue had been removed. Patients who had early debridement had an average of 5.5 debridements compared to an average of three debridements for patients who had initial debridement more than two weeks after presentation. By almost all indicators, early debridement was associated with a worse outcome: higher net initial three days fluids, more frequent transfusion, and seven-fold increase in the rate of major complications, said Dr. Hungness. Moreover, four of the early debridement patients died for a mortality rate of 29 percent compared to two deaths or an 11 percent mortality rate in the late debridement group. "An unusual aspect of this group is that the incidence of Candida was unexpectedly high infecting a third of the patients," said Dr. Hungness. But, he mentioned it is unclear if Candida contributed to the poor outcome. Dr. Stuart Wilson of the Medical College of Wisconsin, Milwaukee, Wisconsin, United States, said the most likely explanation for the poor outcome was the decision to initiate debridement early. He points out that at his institution, acute necrotizing pancreatitis is managed medically. If debridement is needed, "it is delayed and is done as single, closed procedure." He said that following this procedure resulted in an "overall mortality rate of 6 percent at our hospital." E-mail this page to a friend or colleague! To print, use this version