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The Role of Organ Failure

Flavio G. Rocha, MD; Eric Benoit, MD; Michael J. Zinner, MD; Edward E. Whang, MD; Peter A. Banks, MD; Stanley W. Ashley, MD; Koenraad J. Mortele, MD

Arch Surg. 2009;144(3):261-265.

Background  Our group previously reported that organ failure and mortality in necrotizing pancreatitis (NP) are not different between patients with infected and sterile necrosis. Since that report, management of this disease has evolved to include image-guided percutaneous catheter drainage (PCD) to improve morbidity and mortality. We evaluated the effect of PCD on mortality in NP.

Design  Retrospective analysis.

Setting  Tertiary care referral center.

Patients  A total of 689 consecutive patients treated for acute pancreatitis between 2001 and 2005, of whom 64 (9.3%) had pancreatic necrosis documented on contrast-enhanced computed tomography.

Main Outcome Measures  Mortality and organ failure.

Results  In the 64 patients with documented NP, overall mortality was 16%. Thirty-six patients (56%) had organ failure according to the Atlanta classification. Compared with patients with sterile necrosis, those with infected necrosis did not have an increased prevalence of organ failure or increased need for intubation, pressors, or dialysis but had an increased mortality. Mortality in patients treated conservatively was 1 of 29 (3%); in those with PCD alone, 6 of 11 (55%); in those with PCD and surgery, 2 of 17 (12%); and in those with surgery alone, 1 of 7 (14%). All patients treated with PCD alone had organ failure, whereas 10 (59%) of those with PCD and surgery had organ failure.

Conclusion  The use of PCD did not improve the mortality of NP among patients with organ failure.

Author Affiliations: Departments of Surgery (Drs Rocha, Benoit, Zinner, Whang, and Ashley), Medicine (Dr Banks), and Radiology (Dr Mortele), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

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