Rebhun Jeffrey, Nassani Najib, Pan Alex, Hong Mindy, Shuja Asim
Department of Internal Medicine, University of Illinois at Chicago, Chicago, USA.
Department of Gastroenterology and Hepatology, University of Illinois at Chicago, Chicago, USA.
Cureus. 2021 Jan 28;13(1):e12972. doi: 10.7759/cureus.12972.
Background Walled-off pancreatic necrosis (WOPN) represents an encapsulated collection of necrotic pancreatic or peripancreatic tissue that tends to develop four weeks after the onset of acute necrotizing pancreatitis. When infected, it is managed initially by antibiotic therapy before drainage by endoscopic, percutaneous, or surgical means. This study aims to describe the morbidity, mortality, length of stay (LOS), and cost of care associated with open surgical, laparoscopic, and radiology-guided percutaneous drainage in adult patients with infected WOPN. Methods Using the Nationwide Inpatient Sample (NIS), patients aged 18 years and older discharged with the diagnosis of WOPN between January 1, 2016 and December 31, 2016 who underwent open, laparoscopic, or percutaneous drainage were included. Patients' characteristics including age, gender, and body mass index were reported. The primary endpoints were the mortality rate as well as length and cost of stay in each group. The secondary endpoint was the rate of procedural complications in each arm. Endpoints were reported and compared with studies assessing similar outcomes. Statistical Analysis System (SAS) statistical software (SAS Institute Inc., Cary, NC, USA) was used to perform the analysis. Results A total of 229 patients with the diagnosis of acute pancreatitis with infected necrosis were identified. Of these 229 patients, 27, 15, and 20 underwent open, laparoscopic, and percutaneous drainage, respectively. A total of eight studies were used for comparison of outcome variables. Mortality rate was found to be similar among comparison studies. LOS and costs varied widely among studies. There were significantly fewer pancreatic fistula and significantly more multi-organ failure complications as a result of open necrosectomy in the NIS study sample. Conclusion Overall, in analyzing the outcomes of patients undergoing intervention for infected WOPN through the 2016 NIS database, it appears that the database is representative of the majority of outcomes seen in similar clinical trials.
背景 包裹性胰腺坏死（WOPN）是指胰腺或胰周坏死组织的包裹性积聚，往往在急性坏死性胰腺炎发作四周后形成。当发生感染时，最初通过抗生素治疗，然后通过内镜、经皮或手术方式进行引流。本研究旨在描述成年感染性WOPN患者接受开放手术、腹腔镜手术和放射学引导下经皮引流的发病率、死亡率、住院时间（LOS）和护理费用。方法 使用全国住院患者样本（NIS），纳入2016年1月1日至2016年12月31日期间出院诊断为WOPN并接受开放、腹腔镜或经皮引流的18岁及以上患者。报告患者的特征，包括年龄、性别和体重指数。主要终点是每组的死亡率以及住院时间和费用。次要终点是每组的手术并发症发生率。报告终点并与评估类似结果的研究进行比较。使用统计分析系统（SAS）统计软件（美国北卡罗来纳州卡里市SAS研究所）进行分析。结果 共确定229例诊断为急性胰腺炎合并感染性坏死的患者。在这229例患者中，分别有27例、15例和20例接受了开放手术、腹腔镜手术和经皮引流。总共八项研究用于比较结果变量。在比较研究中发现死亡率相似。不同研究之间住院时间和费用差异很大。在NIS研究样本中，开放坏死组织清除术后胰腺瘘显著减少，多器官功能衰竭并发症显著增多。结论 总体而言，通过2016年NIS数据库分析感染性WOPN患者的干预结果，该数据库似乎代表了类似临床试验中所见的大多数结果。
