Severe pancreatitis patients who witness the failure of percutaneous drainage have greater death rates and fare worse than patients who undergo surgery as the initial therapeutic intervention. Patients having necrotizing pancreatitis and a raised APACHE II score might warrant surgery over a drainage-first approach.

A study was performed to determine the characteristics of severe pancreatitis patients who failed percutaneous drainage and comparatively evaluate their outcomes with patients who underwent surgical intervention as the primary therapeutic intervention.

A retrospective review of a prospectively gathered emergency general surgery registry of severe pancreatitis individuals admitted to a tertiary-care center who underwent a therapeutic intervention was performed (2010-2018). Overall, 129 patients (average age was 51.0 ± 14 years) that were diagnosed with severe pancreatitis were included.

Participants were allocated into successful drainage, drainage failure (defined as the requirement for surgical intervention), and surgery first groups. The primary endpoint was mortality while the secondary endpoints were readmission rates, pancreatic insufficiency rates, intensive care unit and total length of stay, and ventilator days.

Notably, 50 (38.8%) patients underwent surgical intervention as their initial treatment modality. Among 79 patients (61.2%) who underwent drainage, 34 (43.0%) were in the drainage failure group and progressed to surgery. Within that group,  about 19 (55.9%) subjects underwent open necrosectomy.

In comparison with the successful drainage group, the drainage failure group was more likely to have a higher Acute Physiology and Chronic Health Evaluation (APACHE) II score,  minimized rates of peripancreatic fluid collections, and an elevated rate of necrotizing pancreatitis.

In the drainage failure and surgery first groups, the mortality was found to be higher compared to the successful drainage group. In the drainage failure group, the total length of stay and intensive care unit length of stay was highest compared to the other two groups, as depicted in the following table:

Patients having severe pancreatitis and who report the failure of percutaneous drainage fare worse than patients who undergo surgery as the initial therapeutic intervention. Patients having necrotizing pancreatitis and an elevated APACHE II score might warrant surgery compared to percutaneous drainage.