Publication

Timing of surgical intervention in necrotizing pancreatitis

Besselink, M. G. H., Verwer, T. J., Schoenmaeckers, E. J. P., Buskens, E., Ridwan, B. U., Visser, M. R., Nieuwenhuijs, V. B. & Gooszen, H. G., Dec-2007, In : Archives of Surgery. 142, 12, p. 1194-1201 8 p.

Research output: Contribution to journalArticleAcademicpeer-review

APA

Besselink, M. G. H., Verwer, T. J., Schoenmaeckers, E. J. P., Buskens, E., Ridwan, B. U., Visser, M. R., ... Gooszen, H. G. (2007). Timing of surgical intervention in necrotizing pancreatitis. Archives of Surgery, 142(12), 1194-1201.

Author

Besselink, Marc G. H. ; Verwer, Thomas J. ; Schoenmaeckers, Ernst J. P. ; Buskens, Erik ; Ridwan, Ben U. ; Visser, Maarten R. ; Nieuwenhuijs, Vincent B. ; Gooszen, Hein G. / Timing of surgical intervention in necrotizing pancreatitis. In: Archives of Surgery. 2007 ; Vol. 142, No. 12. pp. 1194-1201.

Harvard

Besselink, MGH, Verwer, TJ, Schoenmaeckers, EJP, Buskens, E, Ridwan, BU, Visser, MR, Nieuwenhuijs, VB & Gooszen, HG 2007, 'Timing of surgical intervention in necrotizing pancreatitis', Archives of Surgery, vol. 142, no. 12, pp. 1194-1201.

Standard

Timing of surgical intervention in necrotizing pancreatitis. / Besselink, Marc G. H.; Verwer, Thomas J.; Schoenmaeckers, Ernst J. P.; Buskens, Erik; Ridwan, Ben U.; Visser, Maarten R.; Nieuwenhuijs, Vincent B.; Gooszen, Hein G.

In: Archives of Surgery, Vol. 142, No. 12, 12.2007, p. 1194-1201.

Research output: Contribution to journalArticleAcademicpeer-review

Vancouver

Besselink MGH, Verwer TJ, Schoenmaeckers EJP, Buskens E, Ridwan BU, Visser MR et al. Timing of surgical intervention in necrotizing pancreatitis. Archives of Surgery. 2007 Dec;142(12):1194-1201.


BibTeX

@article{e1789552e2aa4bd8b7c5062454af696c,
title = "Timing of surgical intervention in necrotizing pancreatitis",
abstract = "Objective: To determine the effect of timing of surgical intervention for necrotizing pancreatitis.Design: Retrospective study of 53 patients and a systematic review.Setting: A tertiary referral center.Main Outcome Measure: Mortality.Results: Median timing of the intervention was 28 days. Eighty-three percent of patients had infected necrosis and 55{\%} had preoperative organ failure. The mortality rate was 36{\%}. Sixteen patients were operated on within 14 days of initial admission, 11 patients from day 15 to 29, and 26 patients on day 30 or later. This latter group received preoperative antibiotics for a longer period (P <.001), and Candida species and antibiotic-resistant organisms were more often cultured from the pancreatic or peripancreatic necrosis in these patients (P = .02). The 30-day group also had the lowest mortality (8{\%} vs 75{\%} in the 1 to 14-days group and 45{\%} in the 15 to 29 days group, P <.001); this difference persisted when outcome was stratified for preoperative organ failure. During the second half of the study, necrosectomy was further postponed (43 vs 20 days, P = .06) and mortality decreased (22{\%} vs 47{\%}, P = .09). We also reviewed 11 studies with a total of 1136 patients. Median surgical patient volume was 8.3 patients per year (range, 5.3-15.6), median timing of surgical intervention was 26 days (range, 3-31), and median mortality was 25{\%} (range, 6{\%}-56{\%}). We observed a significant correlation between timing of intervention and mortality (R = -0.603; 95{\%} confidence interval, -2.10 to -0.02; P = .05).Conclusion: Postponing necrosectomy until 30 days after initial hospital admission is associated with decreased mortality, prolonged use of antibiotics, and increased incidence of Candida species and antibiotic-resistant organisms.",
keywords = "ANTIBIOTIC-TREATMENT, INCREASED MORTALITY, DOUBLE-BLIND, NECROSECTOMY, INFECTION, NECROSIS, MANAGEMENT, SURGERY, THERAPY, COMPLICATIONS",
author = "Besselink, {Marc G. H.} and Verwer, {Thomas J.} and Schoenmaeckers, {Ernst J. P.} and Erik Buskens and Ridwan, {Ben U.} and Visser, {Maarten R.} and Nieuwenhuijs, {Vincent B.} and Gooszen, {Hein G.}",
year = "2007",
month = "12",
language = "English",
volume = "142",
pages = "1194--1201",
journal = "Archives of Surgery",
issn = "0004-0010",
publisher = "AMER MEDICAL ASSOC",
number = "12",

}

RIS

TY - JOUR

T1 - Timing of surgical intervention in necrotizing pancreatitis

AU - Besselink, Marc G. H.

AU - Verwer, Thomas J.

AU - Schoenmaeckers, Ernst J. P.

AU - Buskens, Erik

AU - Ridwan, Ben U.

AU - Visser, Maarten R.

AU - Nieuwenhuijs, Vincent B.

AU - Gooszen, Hein G.

PY - 2007/12

Y1 - 2007/12

N2 - Objective: To determine the effect of timing of surgical intervention for necrotizing pancreatitis.Design: Retrospective study of 53 patients and a systematic review.Setting: A tertiary referral center.Main Outcome Measure: Mortality.Results: Median timing of the intervention was 28 days. Eighty-three percent of patients had infected necrosis and 55% had preoperative organ failure. The mortality rate was 36%. Sixteen patients were operated on within 14 days of initial admission, 11 patients from day 15 to 29, and 26 patients on day 30 or later. This latter group received preoperative antibiotics for a longer period (P <.001), and Candida species and antibiotic-resistant organisms were more often cultured from the pancreatic or peripancreatic necrosis in these patients (P = .02). The 30-day group also had the lowest mortality (8% vs 75% in the 1 to 14-days group and 45% in the 15 to 29 days group, P <.001); this difference persisted when outcome was stratified for preoperative organ failure. During the second half of the study, necrosectomy was further postponed (43 vs 20 days, P = .06) and mortality decreased (22% vs 47%, P = .09). We also reviewed 11 studies with a total of 1136 patients. Median surgical patient volume was 8.3 patients per year (range, 5.3-15.6), median timing of surgical intervention was 26 days (range, 3-31), and median mortality was 25% (range, 6%-56%). We observed a significant correlation between timing of intervention and mortality (R = -0.603; 95% confidence interval, -2.10 to -0.02; P = .05).Conclusion: Postponing necrosectomy until 30 days after initial hospital admission is associated with decreased mortality, prolonged use of antibiotics, and increased incidence of Candida species and antibiotic-resistant organisms.

AB - Objective: To determine the effect of timing of surgical intervention for necrotizing pancreatitis.Design: Retrospective study of 53 patients and a systematic review.Setting: A tertiary referral center.Main Outcome Measure: Mortality.Results: Median timing of the intervention was 28 days. Eighty-three percent of patients had infected necrosis and 55% had preoperative organ failure. The mortality rate was 36%. Sixteen patients were operated on within 14 days of initial admission, 11 patients from day 15 to 29, and 26 patients on day 30 or later. This latter group received preoperative antibiotics for a longer period (P <.001), and Candida species and antibiotic-resistant organisms were more often cultured from the pancreatic or peripancreatic necrosis in these patients (P = .02). The 30-day group also had the lowest mortality (8% vs 75% in the 1 to 14-days group and 45% in the 15 to 29 days group, P <.001); this difference persisted when outcome was stratified for preoperative organ failure. During the second half of the study, necrosectomy was further postponed (43 vs 20 days, P = .06) and mortality decreased (22% vs 47%, P = .09). We also reviewed 11 studies with a total of 1136 patients. Median surgical patient volume was 8.3 patients per year (range, 5.3-15.6), median timing of surgical intervention was 26 days (range, 3-31), and median mortality was 25% (range, 6%-56%). We observed a significant correlation between timing of intervention and mortality (R = -0.603; 95% confidence interval, -2.10 to -0.02; P = .05).Conclusion: Postponing necrosectomy until 30 days after initial hospital admission is associated with decreased mortality, prolonged use of antibiotics, and increased incidence of Candida species and antibiotic-resistant organisms.

KW - ANTIBIOTIC-TREATMENT

KW - INCREASED MORTALITY

KW - DOUBLE-BLIND

KW - NECROSECTOMY

KW - INFECTION

KW - NECROSIS

KW - MANAGEMENT

KW - SURGERY

KW - THERAPY

KW - COMPLICATIONS

M3 - Article

VL - 142

SP - 1194

EP - 1201

JO - Archives of Surgery

JF - Archives of Surgery

SN - 0004-0010

IS - 12

ER -

ID: 4656021