Long-term Outcome After Open Treatment of Severe Intra-abdominal Infection and Pancreatic Necrosis

Kriwanek, S.; Armbruster, C; Dittrich, Klaus R.; Beckerhinn, Philipp; Schwarzmaier, Alexandra; Redl, E

doi:10.1001/archsurg.133.2.140

Cited by 21 publications

(32 citation statements)

References 29 publications

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“…[6][7][8][9]11,[13][14][15][16][17][18][19][20] Table 2 demonstrates methodological quality of the included studies. 7,9,11,13,14,[17][18][19][20][21][22] One study did not report any No studies investigated the effect of a specific intervention on QoL in AP.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Nine of the 16 studies used the SF-36 (also known as the RAND 36-item health survey), 6,9,13,14,[17][18][19][20][21] which is often considered the criterion standard to measure patient-perceived health. 19,20 Three of 16 studies used the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30), 8,12,21 a cross-culturally valid psychometric instrument to assess QoL.…”

Section: Quality Of Life Toolsmentioning

confidence: 99%

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Quality of Life After Acute Pancreatitis

et al. 2014

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Patient-centered outcomes, including quality of life (QoL), after acute pancreatitis (AP) remain largely unknown. Our aim was to systematically review the best available evidence on QoL after AP. English-language articles on the effect of AP on QoL were identified in MEDLINE, EMBASE, and Scopus. Results were statistically aggregated to obtain a pooled mean difference (MD) and corresponding 95% confidence interval (CI) for individual QoL domains and component summaries, where appropriate. A total of 16 prospective observational studies encompassing 687 AP patients were included. Four studies comprising 267 AP patients, as measured by SF-36 and SF-12 questionnaires, were suitable for meta-analysis. The general health and vitality domains were significantly worse in the patients compared with healthy controls (MD, -10.90; 95% CI, -15.63 to -6.17; P < 0.00001 and MD, -4.64; 95% CI, -7.32 to -1.95; P = 0.0007, respectively). The remaining individual domains and physical and mental component summary scores did not differ between patients and controls. The QoL seems to be significantly impaired in patients after AP with a need to standardize reporting on QoL. Future studies should investigate the effect of different interventions on patients' QoL.

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Section: Study Characteristicsmentioning

confidence: 99%

Section: Quality Of Life Toolsmentioning

confidence: 99%

Quality of Life After Acute Pancreatitis

et al. 2014

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“…Das Ausmaû der Funktionstörun-gen hängt in erheblichem Maûe vom Anteil des untergegangenen Pankreasgewebes ab [59]. Die Incidenz des Diabetes mellitus beträgt nach akuter Pankreatitis (milde und schwere Verlaufsformen zusammengenommen) zwischen 1 und 15 % [3,48] Nach chirurgischer Therapie der Nekrosen erhöht sich die Diabetesrate, sie beträgt in den bisher publizierten Studien zwischen 40 und 90 %, wobei die Nekrosektomie im Vergleich zu den resezierenden Verfahren deutlich günstigere Zahlen aufweist; nach Nekrosektomie kann von einer Incidenz zwischen 40 und 60 % [12,16,30,31] ausgegangen werden, verglichen mit 60 bis 100 % nach klassischer Pankreasresektion [16,17,36,53]. ¾hnliche Ergebnisse finden sich bezüglich der exokrinen Pankreasinsuffizienz: Die Angaben hierzu schwanken zwischen 15 und 70 % nach Nekrosektomie und 70±90 % nach Pankreasresektion [12,17,53,59].…”

Section: Spätergebnisse Nach Nekrosektomieunclassified

Nekrosektomie oder anatomiegerechte Resektion bei akuter Pankreatitis

Beger

Rau

Isenmann

2000

Chirurg

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Necrotizing pancreatitis is still associated with considerable morbidity and mortality. Formerly, surgical treatment with early and extensive pancreatic resection has been the standard. Improvements in our understanding of the pathogenesis of the disease and progress in the field of intensive care therapy have made conservative therapy the initial standard in the treatment of necrotizing pancreatitis. A considerable percentage of patients with sterile necrosis can be managed with low morbidity and mortality by conservative treatment without operation. Nevertheless, surgical treatment is indicated in patients with infected necrosis and in sterile necrosis if multiorgan failure persists over a limited period of time despite maximum intensive care therapy. Pancreatic resection should be abandoned for surgical treatment of pancreatic necrosis, as results with regard to morbidity, mortality and long-term outcome are unsatisfactory. Today the surgical standard is careful digital necrosectomy, which must be followed by either postoperatve drainage, repeated open lavage or continuous closed lavage. In experienced hands, all three procedures provide similar results with regard to morbidity and mortality.

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“…The high incidence of SCIAS compounds the complexity of care required to treat the disease and its complications, creating a large resource burden for health systems globally. Estimates of the cost of standard care per case in the Netherlands was 86,077 USD in 2010; in Austria, the effective cost "per survivor" was reported as 232,400 USD in 1998 [4,5].…”

Section: Introductionmentioning

confidence: 99%

Protocol for a parallel economic evaluation of a trial comparing two surgical strategies in severe complicated intra-abdominal sepsis: the COOL-cost study

et al. 2020

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Background: The risk of death in severe complicated intra-abdominal sepsis (SCIAS) remains high despite decades of surgical and antimicrobial research. New management strategies are required to improve outcomes. The Closed Or Open after Laparotomy (COOL) trial investigates an open-abdomen (OA) approach with active negative pressure peritoneal therapy. This therapy is hypothesized to better manage peritoneal bacterial contamination, drain inflammatory ascites, and reduce the risk of intra-abdominal hypertension leading to improved survival and decreased complications. The total costs and cost-effectiveness of this therapy (as compared with standard fascial closure) are unknown. Methods:We propose a parallel cost-utility analysis of this intervention to be conducted alongside the 1-year trial, extrapolating beyond that using decision analysis. Using resource use metrics (e.g., length of stay, re-admissions) from patients at all study sites and microcosting data from patients enrolled in Calgary, Alberta, the mean cost difference between treatment arms will be established from a publicly-funded health care payer perspective. Quality of life will be measured at 6 months and 1 year postoperatively with the Euroqol EQ-5D-5 L and SF-36 surveys. A within-trial analysis will establish cost and utility at 1 year, using a bootstrapping approach to provide confidence intervals around an estimated incremental cost-effectiveness ratio. If neither operative strategy is economically dominant, Markov modeling will be used to extrapolate the cost per quality-adjusted life years gained to 2-, 5-, 10-year, and lifetime horizons. Future costs and benefits will be discounted at 1.5% per annum. A cost-effectiveness acceptability curve will be generated using Monte Carlo simulation. If all trial outcomes are similar, the primary analysis will default to a cost-minimization approach. Subgroup analysis will be carried out for patients with and without septic shock at presentation, and for patients whose initial APACHE II scores are > 20 versus ≤ 20.Discussion: In addition to an estimate of the clinical effectiveness of an OA approach for SCIAS, an understanding of its cost effectiveness will be required prior to its adoption in any resource-constrained environment. We will estimate this key parameter for use by clinicians and policymakers.

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Long-term Outcome After Open Treatment of Severe Intra-abdominal Infection and Pancreatic Necrosis

Cited by 21 publications

References 29 publications

Quality of Life After Acute Pancreatitis

Quality of Life After Acute Pancreatitis

Nekrosektomie oder anatomiegerechte Resektion bei akuter Pankreatitis

Protocol for a parallel economic evaluation of a trial comparing two surgical strategies in severe complicated intra-abdominal sepsis: the COOL-cost study

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