Risk Factors Influencing Mortality in Open Necrosectomy for Acute Pancreatitis: A Comparative Analysis

<b>Background and Objectives</b>: Patients undergoing open necrosectomy (ON) for acute pancreatitis (AP) often face high morbidity and mortality rates. This study aims to identify risk factors associated with adverse outcomes by comparing survivors and non-survivors of ON. <b>Materials and Methods</b>: A retrospective analysis was conducted on 74 patients who underwent ON for AP. Patients were divided into two groups: survivors (n = 52) and non-survivors (n = 22). Preoperative and postoperative variables were compared, and <i>p</i>-values were calculated to identify significant differences. <b>Results</b>: The mortality rate was 29.73%. Significant risk factors for mortality included age over 60 (<i>p</i> = 0.008), multiple organ failure (<i>p</i> = 0.001), early necrosectomy before 28 days (<i>p</i> = 0.001), higher neutrophil-to-lymphocyte ratio (NLR) (<i>p</i> = 0.045), and postoperative complications such as bleeding (<i>p</i> = 0.005) and intestinal fistula (<i>p</i> = 0.038). Delayed ON after 28 days showed a significantly lower mortality rate (12.5%) compared to early ON (50%). <b>Conclusions</b>: Age, severity of AP, timing of ON, and postoperative complications significantly influence mortality rates in patients undergoing ON. Delaying surgery beyond 28 days and optimizing surgical techniques may improve patient outcomes.