Acute necrotising pancreatitis carries high mortality, especially if infected necrosis
occurs. While percutaneous drainage may be required when internal drainage is not
feasible, reliable guidelines for managing percutaneous drains are lacking. This study
aimed to assess the common practice of percutaneous drainage therapy for infected
pancreatic necrosis.This retrospective study among 29 tertiary care centres included
all patients hospitalised for necrotising acute pancreatitis from 01/2016 until 12/2022
with at least one percutaneous drain. The length of hospital stay was the primary
endpoint, with mortality as the secondary endpoint. Between-group comparisons were
conducted using the ratio of restricted mean survival time (RMST) after adjusting
for confounders.585 patients (67% male) from 29 tertiary care centres in 15 countries
in Europe, Canada and Bolivia were included in the analysis. Length of hospitalisation
or mortality did not differ between the flushed (n = 398) and non-flushed groups (RMST
ratio 1.04, p-value = 0.42 and RMST ratio 1.05, p-value = 0.1 respectively). Mortality
was significantly lower in those patients who received a combination of percutaneous
and internal drains (dual-modality drainage, n = 243) as compared to those who received
percutaneous drains only (RMST ratio 1.05, p-value = 0.01). Flushing with antibiotics
as compared to saline was not associated with shorter length of hospital stay or lower
mortality (RMST ratio 0.98, p-value = 0.78 and 0.97, p-value = 0.48 respectively).This
study reveals notable differences in therapeutic concepts and flushing management
for percutaneous drains. While flushing itself was not associated with a shorter length
of hospitalisation or lower in-hospital mortality, a lower mortality was observed
when internal and percutaneous drainage were used in combination.The study was prospectively
registered in the German Clinical Trials Register (Deutsches Register Klinischer Studien,
DRKS) under the registration number DRKS00032231.
