F. Mannan1, R. C. Gill1, A. R. Alvi1 1The Aga Khan University Hospital Karachi,General Surgery,Karachi, SINDH, Pakistan
Introduction:
The main purpose of this study was to review the trends in management of patients presenting with acute necrotizing pancreatitis (ANP) over the last seven years and its effect on morbidity and mortality.
Methods:
A retrospective cohort study was conducted on all patients presenting with the diagnosis of acute necrotizing pancreatitis presenting to the Aga Khan University Hospital in between the year 2008 to 2015. The study population was broadly categorized in to two groups based on the way these were managed. The first group consisted of patient who underwent surgery for acute necrotizing pancreatitis while the second group was composed of those who were conservatively managed. Patient outcomes were assessed in terms of hospital stay, complication rates and in-hospital mortality. Data was analysed using SPSS version 20. Comparison of outcomes between two groups was done using chi-square test, Fischer exact test or t-test wherever applicable. A p-value of less than 0.05 was considered statistically significant.
Results:
A total of n=110 patients were included in the study with 68% (n=75) males and 32% (n=35) females. Nasojejunal route was found to be the most commonly utilized route of feeding in these patients consisting of around 49% (n=54) patients with forty percent (n=44) tolerating direct oral diet. The outcomes in both these groups in terms of hospital stay, complication rate, and in hospital mortality were not found to be statistically significant. The conservative group however was significant in terms of cost-effectiveness which was shown by a p value of (0.035). The management of this clinically important disease over the years showed an increased trend towards conservative approach in our institute.
Conclusion:
Our study further substantiates the recent global trend of conservative approach towards managing patients with acute necrotizing pancreatitis as reflected in the recent available literature. Though both our study groups were comparable in terms of hospital stay, complications and mortality but conservative measures were seen to be more cost effective in the long term.