Unrecognized necrosis at same admission cholecystectomy for pancreatitis increases organ failure and infected necrosis

Wilson Tak Yu Kwong, Santhi Swaroop Vege

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background and aims: Guidelines recommend same admission cholecystectomy (SAC) in the management of mild acute gallstone pancreatitis (AGP) with a recent randomized trial supporting this recommendation. However, the push for early cholecystectomy will lead a subset of patients with evolving, unrecognized necrotizing pancreatitis (NP) to undergo laparoscopic cholecystectomy (LC) with unknown consequences. With concerns about potentially serious outcomes, we studied the outcomes in patients with unrecognized NP who underwent SAC and identified predictors of unrecognized NP at the time of SAC. Methods: Retrospective study of patients who appeared to have mild AGP but subsequently discovered to have unrecognized NP after SAC (study group). Outcomes were compared to a similar cohort with necrotizing AGP who did not undergo SAC (control group 1). Predictors for unrecognized NP at the time of SAC were identified through logistic regression using a second control group with truly mild AGP undergoing SAC. Results: Patients in the study group (N = 46) undergoing SAC demonstrated higher rates of persistent organ failure (p = 0.0003), infected necrosis (p = 0.02), and length of hospital stay (p = 0.049) compared to a similar group (N = 48) with necrotizing AGP who did not undergo SAC. Persistent SIRS (p < 0.0001) and WBC >12 × 109/L (p < 0.0001) on the day of cholecystectomy were associated with evolving/unrecognized NP. Conclusions: Unrecognized NP at the time of SAC is associated with increased rates of subsequent persistent organ failure, infected necrosis, and length of hospital stay. Persistent leukocytosis and SIRS at the time of proposed cholecystectomy are predictive of unrecognized NP and should prompt contrast enhanced CT prior to proceeding with LC.

Original languageEnglish (US)
JournalPancreatology
DOIs
StateAccepted/In press - Jul 25 2016

Fingerprint

Cholecystectomy
Pancreatitis
Necrosis
Gallstones
Length of Stay
Acute Necrotizing Pancreatitis
Laparoscopic Cholecystectomy
Control Groups
Leukocytosis
Retrospective Studies
Logistic Models
Guidelines

Keywords

  • Gallstone pancreatitis
  • Infected necrosis
  • Laparoscopic cholecystectomy
  • Pancreas
  • SIRS
  • Timing

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Hepatology
  • Endocrinology

Cite this

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title = "Unrecognized necrosis at same admission cholecystectomy for pancreatitis increases organ failure and infected necrosis",
abstract = "Background and aims: Guidelines recommend same admission cholecystectomy (SAC) in the management of mild acute gallstone pancreatitis (AGP) with a recent randomized trial supporting this recommendation. However, the push for early cholecystectomy will lead a subset of patients with evolving, unrecognized necrotizing pancreatitis (NP) to undergo laparoscopic cholecystectomy (LC) with unknown consequences. With concerns about potentially serious outcomes, we studied the outcomes in patients with unrecognized NP who underwent SAC and identified predictors of unrecognized NP at the time of SAC. Methods: Retrospective study of patients who appeared to have mild AGP but subsequently discovered to have unrecognized NP after SAC (study group). Outcomes were compared to a similar cohort with necrotizing AGP who did not undergo SAC (control group 1). Predictors for unrecognized NP at the time of SAC were identified through logistic regression using a second control group with truly mild AGP undergoing SAC. Results: Patients in the study group (N = 46) undergoing SAC demonstrated higher rates of persistent organ failure (p = 0.0003), infected necrosis (p = 0.02), and length of hospital stay (p = 0.049) compared to a similar group (N = 48) with necrotizing AGP who did not undergo SAC. Persistent SIRS (p < 0.0001) and WBC >12 × 109/L (p < 0.0001) on the day of cholecystectomy were associated with evolving/unrecognized NP. Conclusions: Unrecognized NP at the time of SAC is associated with increased rates of subsequent persistent organ failure, infected necrosis, and length of hospital stay. Persistent leukocytosis and SIRS at the time of proposed cholecystectomy are predictive of unrecognized NP and should prompt contrast enhanced CT prior to proceeding with LC.",
keywords = "Gallstone pancreatitis, Infected necrosis, Laparoscopic cholecystectomy, Pancreas, SIRS, Timing",
author = "Kwong, {Wilson Tak Yu} and Vege, {Santhi Swaroop}",
year = "2016",
month = "7",
day = "25",
doi = "10.1016/j.pan.2016.10.009",
language = "English (US)",
journal = "Pancreatology",
issn = "1424-3903",
publisher = "S. Karger AG",

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TY - JOUR

T1 - Unrecognized necrosis at same admission cholecystectomy for pancreatitis increases organ failure and infected necrosis

AU - Kwong, Wilson Tak Yu

AU - Vege, Santhi Swaroop

PY - 2016/7/25

Y1 - 2016/7/25

N2 - Background and aims: Guidelines recommend same admission cholecystectomy (SAC) in the management of mild acute gallstone pancreatitis (AGP) with a recent randomized trial supporting this recommendation. However, the push for early cholecystectomy will lead a subset of patients with evolving, unrecognized necrotizing pancreatitis (NP) to undergo laparoscopic cholecystectomy (LC) with unknown consequences. With concerns about potentially serious outcomes, we studied the outcomes in patients with unrecognized NP who underwent SAC and identified predictors of unrecognized NP at the time of SAC. Methods: Retrospective study of patients who appeared to have mild AGP but subsequently discovered to have unrecognized NP after SAC (study group). Outcomes were compared to a similar cohort with necrotizing AGP who did not undergo SAC (control group 1). Predictors for unrecognized NP at the time of SAC were identified through logistic regression using a second control group with truly mild AGP undergoing SAC. Results: Patients in the study group (N = 46) undergoing SAC demonstrated higher rates of persistent organ failure (p = 0.0003), infected necrosis (p = 0.02), and length of hospital stay (p = 0.049) compared to a similar group (N = 48) with necrotizing AGP who did not undergo SAC. Persistent SIRS (p < 0.0001) and WBC >12 × 109/L (p < 0.0001) on the day of cholecystectomy were associated with evolving/unrecognized NP. Conclusions: Unrecognized NP at the time of SAC is associated with increased rates of subsequent persistent organ failure, infected necrosis, and length of hospital stay. Persistent leukocytosis and SIRS at the time of proposed cholecystectomy are predictive of unrecognized NP and should prompt contrast enhanced CT prior to proceeding with LC.

AB - Background and aims: Guidelines recommend same admission cholecystectomy (SAC) in the management of mild acute gallstone pancreatitis (AGP) with a recent randomized trial supporting this recommendation. However, the push for early cholecystectomy will lead a subset of patients with evolving, unrecognized necrotizing pancreatitis (NP) to undergo laparoscopic cholecystectomy (LC) with unknown consequences. With concerns about potentially serious outcomes, we studied the outcomes in patients with unrecognized NP who underwent SAC and identified predictors of unrecognized NP at the time of SAC. Methods: Retrospective study of patients who appeared to have mild AGP but subsequently discovered to have unrecognized NP after SAC (study group). Outcomes were compared to a similar cohort with necrotizing AGP who did not undergo SAC (control group 1). Predictors for unrecognized NP at the time of SAC were identified through logistic regression using a second control group with truly mild AGP undergoing SAC. Results: Patients in the study group (N = 46) undergoing SAC demonstrated higher rates of persistent organ failure (p = 0.0003), infected necrosis (p = 0.02), and length of hospital stay (p = 0.049) compared to a similar group (N = 48) with necrotizing AGP who did not undergo SAC. Persistent SIRS (p < 0.0001) and WBC >12 × 109/L (p < 0.0001) on the day of cholecystectomy were associated with evolving/unrecognized NP. Conclusions: Unrecognized NP at the time of SAC is associated with increased rates of subsequent persistent organ failure, infected necrosis, and length of hospital stay. Persistent leukocytosis and SIRS at the time of proposed cholecystectomy are predictive of unrecognized NP and should prompt contrast enhanced CT prior to proceeding with LC.

KW - Gallstone pancreatitis

KW - Infected necrosis

KW - Laparoscopic cholecystectomy

KW - Pancreas

KW - SIRS

KW - Timing

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U2 - 10.1016/j.pan.2016.10.009

DO - 10.1016/j.pan.2016.10.009

M3 - Article

JO - Pancreatology

JF - Pancreatology

SN - 1424-3903

ER -