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