Summary of findings 3. Interventions for necrotising pancreatitis for necrotising pancreatitis: secondary outcomes.
| Interventions for necrotising pancreatitis: secondary outcomes | |||||
| Patient or population: people with necrotising pancreatitis Settings: secondary or tertiary care Intervention: various interventions vs. control for necrotising pancreatitis | |||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | |
| Assumed risk | Corresponding risk | ||||
| Control | Intervention | ||||
| Adverse events (number) | |||||
| Peritoneal lavage vs. open necrosectomy | 1696 per 1000 | 1713 per 1000 (1070 to 2742) | Rate ratio 1.01 (0.63 to 1.62) | 21 (1 study) | ⊕⊝⊝⊝ very low1,2,3,4 |
| Minimally invasive step‐up approach vs. open necrosectomy | 1696 per 1000 | 703 per 1000 (431 to 1148) | Rate ratio 0.41 (0.25 to 0.68) | 88 (1 study) | ⊕⊕⊝⊝ low1,3 |
| Minimally invasive step‐up approach: video‐assisted vs. endoscopic | 100 per 1000 | 1170 per 1000 (152 to 8987) | Rate ratio 11.7 (1.52 to 89.87) | 22 (1 study) | ⊕⊝⊝⊝ very low1,3 |
| Length of hospital stay: 5 trials reported the length of hospital stay but this was not reported in a format that could be meta‐analysed. There were no statistically significant differences reported in the length of hospital stay in any of the 5 trials (3 comparisons: peritoneal lavage vs. open necrosectomy (2 trials; 58 participants); minimally invasive step‐up approach vs. open necrosectomy (2 trials; 160 participants); minimally invasive step‐up approach: video‐assisted vs. endoscopic (1 trial; 20 participants)) that provided information on the length of hospital stay | |||||
| Length of ITU stay: 3 trials reported the length of ITU stay but this was not reported in a format that could be meta‐analysed. There was major inconsistency between 2 trials (58 participants) that reported ITU stay in the comparison between peritoneal lavage and open necrosectomy. There was no statistically significant difference in the length of ITU stay between the minimally invasive step‐up approach and open necrosectomy in the only trial (88 participants) that reported this outcome in the comparison between minimally invasive step‐up approach and open necrosectomy | |||||
| Number of treatments: only 1 trial (20 participants) reported the number of treatments in each group, but this was not reported in a format that could be meta‐analysed. The number of treatments were statistically significantly fewer (2 fewer treatments) in the video‐assisted minimally invasive step‐up approach group (median: 1 treatment per participant) compared to endoscopic minimally invasive step‐up approach group (median: 3 treatments per participant) | |||||
| Costs: only 1 trial (88 participants) reported the costs in each group but this was not reported in a format that could be meta‐analysed without imputation of data. The costs were statistically significantly less (USD 11,922 cheaper) in the minimally invasive step‐up approach (mean costs per participant: USD 86,653) compared to open necrosectomy (mean costs per participant: USD 98,575) | |||||
| None of the trials reported the proportion of people with adverse events , requirement for additional invasive intervention , time to return to normal activity , or time to return to work | |||||
| *The basis for the assumed risk is the control event rates across studies. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; ITU: intensive therapy unit. | |||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | |||||
1 The trial(s) was (were) at unclear or high risk of bias. 2 There was moderate heterogeneity as indicated by the I2 statistic. 3 Sample size was small. 4 Confidence intervals overlapped clinically significant effect and no effect.