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This study reviews the resource utilization of patients admitted to the Intensive Care Unit (ICU) with severe necrotizing pancreatitis treated by early necrosectomy. For 21 patients there was a total of 221 abdominal operations, 2365 hospital days, 565 ICU days and 1185 days of parenteral nutrition. The mortality rate was 43%. The treatment for patients with necrotizing pancreatitis is 10 times more resource intense than other admissions to the ICU. The implications of necrotizing pancreatitis treated by necosectomy in the context of a Diagnosis-Related Groups Prospective Payment model of hospital funding are discussed.

To assess prognostication and therapy of 100 patients with acute pancreatitis, a randomized prospective multicentre clinical trial was commenced in August 1982. This study examines the usefulness of four parameters (sex, age, serum amylase and serum aspartate aminotransferase), coincidentally used as part of accurate and reliable prediction of severity of disease, in predicting gallstone aetiology, with an accuracy of 82%. The cost effectiveness and morbidity associated with the treatment of pancreatitis is also examined; patients with mild to moderately severe pancreatitis are better managed with a peripheral intravenous crystalloid solution and routine ward observations, rather than with supplementary urinary catheter and antibiotics. Conclusions about the optimum treatment of patients with severe pancreatitis cannot be made; certainly peritoneal lavage as adjunctive therapy, which has not been shown to be beneficial in larger series of patients with severe pancreatitis, more than doubles the cost per patient and is thus probably not cost effective. The overall morality in this series is 2%.