Abhishek Bhurwal, MD1, Lauren Pioppo, MD1, Augustine Tawadros, MD1, Debashis Reja, MD1, Iman Andalib, MD1, Avik Sarkar, MD2, Haroon Shahid, MD2, Amy Tyberg, MD1, Michel Kahaleh, MD, FACG2
1Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ; 2Robert Wood Johnson University Hospital, New Brunswick, NJ
Introduction: Although most patients develop mild acute pancreatitis, some progress to necrotizing pancreatitis. Necrotizing pancreatitis has historically been associated with increased mortality as high as 30%. However, there are sparse studies reporting incidence of necrotizing pancreatitis from national cohort and its impact on patient related outcomes. Therefore, we aimed to analyze Necrotizing pancreatitis from a National cohort.
Methods: This was a retrospective study utilizing the 2016 National Inpatient Database Cohort for all principal discharges of acute pancreatitis in patients more than 18 years of age utilizing ICD 10 CM codes. Primary outcomes were incidence of necrotizing pancreatitis. Secondary outcomes were mortality, impact on healthcare utilization in terms of length of stay and hospitalization charges. These were then adjusted for confounders utilizing multivariate and Poisson regression analysis. All statistics were performed utilizing STATA software.
Results: Among total of 288,479 discharges with principal diagnoses of Acute Pancreatitis, 0.84% were necrotizing pancreatitis. Necrotizing pancreatitis significantly more frequent in young adults (49 years vs 51 years, p< 0.0001) and male population (52.69% vs 69.83%, p< 0.0001). As expected, presence of necrosis was associated with increased odds of complications such as Acute kidney injury and Acute respiratory distress syndrome. Approximately,7% of the necrotizing pancreatitis cohort was associated with pancreatic resection. Acute necrotizing pancreatitis did not significantly increase the odds of mortality as shown in Table 2 after adjustment of confounders. Presence of necrosis was also associated with significantly longer length of stay in the hospital (4.31 days vs 12.10 days, p< 0.0001) and significantly higher total hospitalization costs (9,264$ vs 29,948$, p< 0.0001)
Discussion: Incidence of Acute necrotizing pancreatitis is approximately 8 per 1000 cases of acute pancreatitis. Even though, necrotizing pancreatitis led to significantly higher longer length of stay and hospitalization charges, mortality was not increased from necrotizing pancreatitis. No significant difference in mortality indirectly indicates aggressive IV fluid therapy, early recognition and resections when indicated. However, further studies are warranted to elucidate the reason explaining necrotizing pancreatitis in young and male population.
Citation: Abhishek Bhurwal, MD; Lauren Pioppo, MD; Augustine Tawadros, MD; Debashis Reja, MD; Iman Andalib, MD; Avik Sarkar, MD; Haroon Shahid, MD; Amy Tyberg, MD; Michel Kahaleh, MD, FACG. P1822 - NECROTIZING PANCREATITIS DOES NOT INCREASE ODDS OF MORTALITY: INSIGHTS FROM A NATIONAL COHORT. Program No. P1822. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.