(1032) Intervention-Related Outcomes in Acute Necrotizing Pancreatitis: A Retrospective Study

Introduction: In acute necrotising pancreatitis (ANP), step-up approach is beneficial as compared to early surgery, though both have considerable morbidity and mortality.

Aim:
To compare the ICU needs and mortality in ANP patients requiring step up approach as compared to surgery.

Methods: Retrospective study in a tertiary ICU over three years. After Ethics clearance, consecutive ANP patients > 18 years of age, admitted for >24 hours in ICU included. Data noted include demographics, severity of illness, life supportive therapies, complications and interventions. Outcomes including days free of organ support, length of ICU stay and survival were compared among the patients requiring various interventions.

Results: 110 patients with ANP were included; 90 (81.8%) were male, median age was 36.5 years (IQR 27.75 to 50), median day of illness was 10 (5.75 to 17), CT severity index was 10 (6 to 10). The etiology was biliary in 58 (53%), alcohol in 34 (31%) and idiopathic in 12 (10.9%). Mechanical ventilatory support was required in 93 patients for median 11.5 days, vasopressor support in 108 for median 10 days, renal replacement therapy (RRT) in 63 (57.3%); ICU stay was 19.5 days (9.75-36.25). Complications were abdominal compartment syndrome in 51 patients (46%) and abdominal vascular complications in 11 (10%); 6 of them required embolization.
45 (40.9%) patients were managed conservatively, 50 underwent percutaneous drainage (PCD) (step-up approach), 13 underwent PCD followed by open necrosectomy and 2 underwent open necrosectomy.
Patients requiring interventions (radiological or surgical) were admitted later in the disease course (12 vs 7 days, p=0.002), had a higher CTSI (10 vs 6, p< 0.001), required RRT more often (69% vs 40%, p=0.002) and stayed significantly longer (30 days vs 10 days, p< 0.001). On multivariable analysis to predict interventions, CTSI and need for RRT were independently associated with need for intervention.
58 (53%) patients died. The mortality rate was 31% in the conservative group, 58% in the step-up group and 100% in step-up followed by surgery and only surgery group.

Conclusions: Among patients with ANP, step-up approach with PCD had a better outcome than open necrosectomy. Patients requiring interventions presented later, had higher CT severity index and required RRT more often.