Adherence to Step-Up Approach in Pancreatic Necrosis in Tertiary Hospital: A Retrospective Study

Background: Acute pancreatitis is a diverse condition that can be potentially life-threatening. The management of infected necrotizing pancreatitis has changed dramatically during the last two decades and continues to evolve with growing experience, new technologies and ongoing research. Aims and Objectives: The aim of this study was to evaluate the practical adoption of the step-up approach in a tertiary hospital setting and to assess the short- and long-term outcomes associated with this approach. Methods: This was a retrospective study done in 146 patients who have met the inclusion and exclusion criteria and was divided into two distinct groups: the ‘adherence group’ who followed the ‘step-up approach,’ and the ‘non-adherence to step-up approach’ group. A thorough comparison and analysis was performed between these to identify the success rate, complication rate, survival rate and potential predictors of mortality. Results: Out of 146 patients, 134 managed with a step-up approach, while 12 patients underwent up front surgery. The study showed an adherence rate of 91.8%. Adherence to step group had a mortality of 22 (16.42%) and nonadherence group had 2 (16.67%) mortality with no statistical difference. The adherence group had a low incidence of new-onset multiorgan failure (9.7%), compared to 25% of the nonadherence group, which was statistically significant. The complication rate (12.66%) was lower in the adherence group as compared to the nonadherence group (50%). Conclusion: The step-up approach can be utilized in the management of IPN with reasonably good adherence in a vast majority of patients. Future research should focus on the development of novel therapeutic strategies aimed at modulating the disease course in IPN.