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2003, Number 2

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Cir Gen 2003; 25 (2)

Morbidity and mortality associated to a protocolized management of acute pancreatitis

Ortega CL, Herrera EJJ, Obregón CL, Pérez TH, Mijares GJM, Cárdenas LLE

Language: Spanish
References: 32
Page: 103-111
PDF size: 78.93 Kb.


ABSTRACT

Objective: To analyze the results from a protocolized management of acute pancreatitis.
Setting: Third level health care hospital.
Design: Intervention study.
Material and methods: The usefulness of a protocol to manage patients with acute pancreatitis was assessed in a prospective experimental study. Patients with a sterile pancreatic necrosis received intensive medical treatment including antibiotic prophylaxis. Those patients with infected pancreatic necrosis were subjected to necrosectomy. Results were compared with those from a previous retrospective study (historical control), in which the non-protocolized management of pancreatic necrosis yielded a mortality of 35%.
Results: From March 1, 1997 to April 30, 1999, 279 patients were studied. In 83.5% of the patients, pancreatitis was edematous interstitial (EIP), sterile pancreatic necrosis (SPN) was found in 12.9% and infected pancreatic necrosis (IPN) in 3.5%. Necrotomy was performed in 10 patients with IPN. Hospital mortality was of 1% for EIP, 5.5% for SPN, and 70% for IPN. Implementation of the protocolized management of acute pancreatitis reduced global mortality from 7.5 to 4.3% (p = 0.180) and in patients with pancreatic necrosis from 35% to 19.5% (p = 0.141).
Conclusion: The implementation of a management protocol for acute pancreatitis allowed to reduce mortality and pancreatic infection frequencies to within recommended standards. Pancreatic necrosis alone did not represent a risk factor for mortality and was treated through surgery safely and efficaciously.


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