Robert Wood Johnson Medical School, Rutgers University Franklin Park, NJ
Savan Kabaria, MD1, Michael Makar, MD2, Anish V. Patel, MD2, Abhishek Bhurwal, MD2; 1Robert Wood Johnson Medical School, Rutgers University, Franklin Park, NJ; 2Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ
Introduction: Acute Pancreatitis (AP) is a common gastrointestinal complication leading to hospitalization. AP can be mild, moderate or severe. While mild pancreatitis is commonly self-limited, severe pancreatitis can be associated with development of complications such as necrotizing pancreatitis (NP). Demographics of NP have not been previously defined. Our aim was to determine the demographic factors leading to the development of necrotizing pancreatitis (NP). Methods: We analyzed the National Inpatient Sample (NIS) database via ICD 10 codes during period from 2016-2017. Inclusion criteria were age between 18 – 90 years, elective admission, and with the primary diagnosis of AP. Patients were stratified by the presence of NP. Multivariate logistic and linear regression models were fit to adjust for patient demographics (age, gender, race, type of insurance, income quartile, Charlson Comorbidity Index) and odds ratio (OR) were determined. The primary outcome measure was demographic predictors of developing NP in all patients with AP. Secondary outcomes were potential causes of NP as well as mortality, hospitalization charges/costs and length of stay associated with NP. Results: Out of 575,229 hospitalizations for AP, 13,205 hospitalizations (2.3%) presented with NP. As shown in Figure 1, males were significantly more likely to develop NP (OR 1.85; 95% CI 1.69 – 2.02; p < 0.001). Additionally, following demographic groups were less likely to develop NP: African Americans (OR 0.72; 95% CI 0.63 – 0.83; p < 0.001), older age groups including 50-64 years (OR 0.83; 95% CI 0.71-0.96; p < 0.05) and above 64 years (OR 0.72; 95% CI 0.62 – 0.85; p < 0.001). Overall inpatient mortality for NP was 3.34%, with average length of stay of 11.2 days and hospitalization costs of $29,168. Comparatively, mortality associated with AP was 0.53%, with average length of stay of 4.2 days and hospitalization costs of $9,042. Overall, 52.9% of NP hospitalizations were classified as idiopathic, 29.4% were associated with alcohol toxicity, 16.5% had biliary origin, and 1.2% were related to drug toxicity. Discussion: NP represent a significant contributor to morbidity and mortality when compared to AP patients without necrosis. There were several demographic predictors of developing NP which require further physiological elucidation. Additionally, majority of NP cases were idiopathic, with alcohol, biliary and drug toxicity representing minority of cases in the stated order.
Figure 1: Demographic predictors of developing necrotizing pancreatitis among patients with acute pancreatitis using multivariate regression model
Disclosures: Savan Kabaria indicated no relevant financial relationships. Michael Makar indicated no relevant financial relationships. Anish Patel indicated no relevant financial relationships. Abhishek Bhurwal indicated no relevant financial relationships.