BACKGROUND: Necrotizing pancreatitis has been associated with mortality rates of 25% to 80%. We reviewed our experience to determine whether aggressive debridement and comprehensive critical care improves survival. METHODS: The records of 989 patients with the diagnosis of pancreatitis admitted between January 1990 and September 1997 were retrospectively reviewed. Twenty-six patients required surgery for necrotizing pancreatitis and are the subjects of this review. RESULTS: Five of twenty-six patients (19%) died. For all patients, mean Ranson's score was 4.3 of 11, mean admission APACHE II score was 17.2, and mean Multiple Organ Dysfunction (MOD) score was 9.1. Poor outcome was associated with infected pancreatic necrosis (P = 0.03), elevated APACHE II score on admission (P = 0.04), and progression of MOD during the week after admission (P = 0.02). CONCLUSIONS: This review demonstrates improved survival in seriously ill patients with necrotizing pancreatitis as a result of comprehensive surgical and critical care.
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