T. K. Maatman1, A. Roch1, M. House1, A. Nakeeb1, E. Ceppa1, C. Schmidt1, K. Wehlage1, R. Cournoyer1, N. Zyromski1 1Indiana University School Of Medicine,Indianapolis, IN, USA
Introduction: Damage Control Laparotomy is a widely accepted practice in trauma surgery. We have applied this approach selectively to severely ill patients requiring open pancreatic débridement. Damage Control Débridement (DCD) is a novel, staged approach to pancreatic débridement; we sought to evaluate outcomes associated with this technique.
Methods: Retrospective review evaluating 75 consecutive patients undergoing open pancreatic débridement between 2006 and 2016. Data were prospectively collected in our institutional Necrotizing Pancreatitis Database. 12 patients undergoing DCD were compared to 63 undergoing single stage débridement (SSD). Two independent groups T-tests and Pearson’s correlations or Fisher’s exact tests were performed to analyze the bivariate relationships between DCD and suspected factors defined pre- and post-operatively. P-values of <0.05 were accepted as statistically significant.
Results: Patients treated by DCD were more severely ill globally. DCD patients had higher incidence of preoperative organ failure, need for ICU admission, APACHE II scores (table), and more profound malnutrition (albumin DCD=1.9 g/dL, SSD=2.5 g/dL; p=0.03). Indications for DCD included: hemodynamic compromise (n=4), medical coagulopathy (n=4), or a combination (n=4). 6 of 12 DCD patients required more than one subsequent débridement prior to definitive abdominal closure (mean number of total débridements=2.6; range 2-4). Length of stay (DCD=43.8, SSD=17.1, p<0.01) and ICU stay (DCD=20.8, SSD=5.9, p<0.01) was longer in DCD patients. However, no difference was seen in the rate of readmission (DCD=42%, SSD=41%, p=0.90) or repeat intervention (any: DCD=58%, SSD=33%, p=0.10; endoscopic: DCD=17%, SSD=11%, p=0.59; percutaneous drain: DCD=42%, SSD=19%, p=0.09; return to OR after abdominal closure: DCD=0%, SSD=13%, p=0.20). The DCD group had a decreased rate of pancreatic fistula (DCD=33%, SSD=65%, p=0.04). Overall mortality was 2.7%; no significant difference in mortality was observed between DCD (8%) and SSD (2%), p=0.19.
Conclusion: Despite having substantially more severe acute illness, necrotizing pancreatitis patients treated with damage control débridement had equivalent morbidity and mortality as those undergoing elective single stage pancreatic débridement. Damage control débridement is an effective technique with which to salvage severely ill necrotizing pancreatitis patients.
