Access conversion as a factor associated with mortality in minimally invasive interventions in patients with pancreatic necrosis

Objective. To evaluate the association of access conversion with 30-day mortality in patients with pancreatic necrosis who underwent minimally invasive interventions, and to identify clinical factors associated with the need for conversion. Material and methods. This prospective comparative multicenter study was conducted in three clinical centers of Kyrgyzstan from January 2019 to December 2024. The study included 105 patients with verified diagnosis of pancreatic necrosis who underwent minimally invasive interventions. Patients were divided into two groups: the main group (n=48, patients with lethal outcome) and the control group (n=57, patients with favorable outcome). Univariate and multivariate logistic regression analysis of six risk factors was performed. Results. Univariate analysis showed that age over 60 years, presence of comorbidities, surgeon’s qualification, and operation duration did not have a statistically significant effect on mortality (p > 0.05). The presence of widespread peritonitis (p=0.03) and conversion to laparotomy (p<0.001) demonstrated a significant association with adverse outcome. According to multivariate analysis, conversion was independently associated with mortality (OR=8.94; 95% CI: 2.81—28.47; p=0.0002). The conversion rate in the main group was 45.8% (n=22), in the control group — 10.5% (n=6). Conclusion. Access conversion in minimally invasive interventions in patients with pancreatic necrosis was significantly associated with 30-day mortality and retained independent significance in a multivariable model including widespread peritonitis. These findings allow considering conversion as an integral marker of an unfavorable clinical scenario and substantiate the need for developing objective criteria for timely transition to open surgery.