CT-guided percutaneous catheter drainage in necrotizing pancreatitis: Outcomes among patients discharged with drains in place

PURPOSE: To evaluate the clinical success of discharging patients with persistent drainage from percutaneous pancreatic catheters and to identify factors related to complications and re-admission. MATERIALS AND METHODS: The authors identified 15 patients with necrotizing pancreatitis who were discharged with drains after computed tomographic (CT)-guided catheter drainage at their institution from 2000 to 2006. At discharge, all patients were afebrile and were tolerating oral diets but had persistent catheter output. Data reviewed included abdominal CT scans (at admission, before drain placement, and before discharge), microbiologic results, catheter caliber, number of catheters, outpatient follow-up, and re-admission records. RESULTS: Seven of the 15 patients (47%) remained clinically well and underwent successful outpatient catheter removal (median duration of catheter drainage, 94 days). Eight of the 15 patients (53%) were re-admitted because of abdominal pain and/or fever (median time to re-admission, 15 days). Six of the eight re-admitted patients (75%) underwent surgical debridement and two (25%) had catheters manipulated followed by eventual successful outpatient catheter removal. The mean percentage reduction in size of the necrotic collection before discharge was higher in the seven patients who remained clinically well compared to the eight who required re-admission (87.6% vs 49.6%, P =.037). CONCLUSIONS: Patients with necrotizing pancreatitis who have persistent drainage from percutaneous catheters at the time of hospital discharge are more likely to be re-admitted if there is CT evidence of inadequate resolution of the necrotic collection.