The impact of surgery on mortality and morbidity in patients with severe acute pancreatitis and intra-abdominal hypertension

Abstract

Objectives: To determine the impact of surgery in mortality and morbidity in patients with severe acute pancreatitis (SAP) and intra-abdominal hypertension (IAH) or low abdominal perfusion pressure (APP). Materials and methods: We performed a case-control study of adult patients who presented with SAP and IAH or low APP defined as APP < 60 mmHg at the intensive care unit (ICU) of a tertiary care center. We evaluated the effect of surgery on mortality, morbidity, hospital and ICU length of stay. Results: We found 48 patients with IAH and 35 patients with low APP. We found no association with mortality. In the subgroup with IAH we found an association of protection for organ failure (adjusted OR = 0.17 [95% CI 0.41–0.69], p = 0.014), respiratory failure (adjusted OR = 0.15 [95% CI 0.04–0.62], p = 0.008) and renal failure (adjusted OR = 0.02 [95% CI 0.00–0.24], p = 0.002), and in the subgroup with low APP an association of protection for kidney failure (OR = 0.06 [95% CI 0.00–0.64], p = 0.012). In both subgroups, hospital and ICU length of stay were increased (p < 0.01). Conclusions: In patients with SAP, surgery seems protective for respiratory and kidney failures in the subgroup with IAH and for kidney failure in the subgroup with low APP, nonetheless, it increases hospital and ICU length of stay.

Keywords:

• severe acute pancreatitis
• intra-abdominal hypertension
• surgery
• mortality
• morbidity

Public Interest Statement

Currently, people who are hospitalized for severe acute pancreatitis (SAP) and intra-abdominal hypertension continue to have a high mortality rate. When a patient has an acute pancreatitis, there can be an increase in pressure within the abdominal cavity so important to cause damage by itself. In severe cases, decompressive surgery may be necessary to stop this ongoing damage. So we evaluated the effect of decompressive surgery in hospitalized patients with SAP and elevated intra-abdominal pressure on the mortality and morbidity outcomes. In our analysis, we found different outcomes among patients with SAP-induced elevated intra-abdominal pressure and/or decreased abdominal circulation, between those who were and were not operated. Our findings don’t support any mortality benefit with surgery, but suggest that there is some degree of protection against development of organ failures, though this is accompanied by an increased risk of infectious complications as well as a prolonged in-hospital stay.

Competing Interests

The authors declare no competing interest.

Additional information

Funding

Funding. The authors received no direct funding for this research.

Notes on contributors

Jorge Hernández Calleros

Jorge Hernández Calleros, MD, MSc is an internist, gastroenterologist and pancreatologist, he is currently an affiliated physician of the National Institute of Medical Science and Nutrition Salvador Zubiran Pancreatic Clinic. He is interested in improving clinical care in gastroenterology and pancreatology, and has many published peer-reviewed articles in this area. This work is relevant as it describes outcomes regarding mortality and morbidity in patients with severe acute pancreatitis and intra-abdominal hypertension and/or low abdominal perfusion pressure who undergo decompressive surgery. Knowledge of these outcomes is useful for physicians in order to guide their clinical decisions regarding the dilemma of performing surgery or not when attending hospitalized patients with these characteristics, as they currently continue to have a high mortality rate.