Clinical Science A contemporary series of patients undergoing open debridement for necrotizing pancreatitis Arin L. Madenci, M.D., M.P.H. a , Maria Michailidou, M.D. a , Grace Chiou, M.D. a , Ashraf Thabet, M.D. b , Carlos Ferna ´ndez-del Castillo, M.D. a , Peter J. Fagenholz, M.D. a, * a Department of Surgery, Division of Trauma Emergency Surgery and Critical Care, b Department of Radiology, Massachusetts General Hospital, 165 Cambridge Street, Boston, MA 02114, USA KEYWORDS: Pancreatic diseases; Acute necrotizing pancreatitis; Debridement; Minimally invasive surgical procedures; Sensitivity and specificity Abstract BACKGROUND: For patients with acute pancreatitis complicated by infected necrosis, minimally invasive techniques have taken hold without substantial comparison with open surgery. We present a contemporary series of open necrosectomies as a benchmark for newer techniques. METHODS: Using a prospective database, we retrospectively identified consecutive patients under- going debridement for necrotizing pancreatitis (2006 to 2009). The primary endpoint was in-hospital mortality. RESULTS: Sixty-eight patients underwent debridement for pancreatic/peripancreatic necrosis. In- hospital mortality was 8.8% (n 5 6). Infection (n 5 43, 63%) and failure-to-thrive (n 5 13, 19%) comprised the most common indications for necrosectomy. The false negative rate (FNR) for infection of percutaneous aspirate was 20.0%. Older age (P 5 .02), Acute Physiology and Chronic Health Eval- uation II score upon admission (P 5 .03) or preoperatively (P , .01), preoperative intensive care unit admission (P 5 .01), and postoperative organ failure (P 5 .03) were associated with mortality. CONCLUSIONS: Open debridement for necrotizing pancreatitis results in a low mortality, providing a useful comparator for other interventions. Given the high FNR of percutaneous aspirate, debridement should not be predicated on proven infection. Ó 2014 Elsevier Inc. All rights reserved. Acute pancreatitis afflicts over 200,000 people annually in the United States and its incidence appears to be increasing. 1 Approximately 20% of patients have disease complicated by necrosis of the pancreatic parenchyma or peripancreatic tissues 2 and 30% of those patients develop infected necrosis. 3 Without some form of interventiond surgical, endoscopic, or percutaneous radiologically guideddinfected necrosis carries an extremely poor prog- nosis. 4,5 The indications, timing, and techniques for inter- vention have recently undergone considerable evolution. 6 In the past, earlier debridement, including for sterile necrosis, was commonplace. Currently, most practitioners Current author affiliations: Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA (A.L. Madenci), Department of Sur- gery, University of Arizona, Phoenix, AZ, USA (M. Michailidou), Depart- ment of Surgery, Stanford University Medical Center, Palo Alto, CA, USA (G. Chiou). There were no relevant financial relationships or any sources of support in the form of grants, equipment, or drugs. The authors declare no conflicts of interest. Abstract presented at the American Pancreatic Association Annual Meeting 2011, Chicago, Illinois. * Corresponding author. Tel.: 11-617-643-2439; fax: 11-617-726-9121. E-mail address: pfagenholz@partners.org Manuscript received October 13, 2013; revised manuscript November 11, 2013 0002-9610/$ - see front matter Ó 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.amjsurg.2013.11.004 The American Journal of Surgery (2014) 208, 324-331