Krista M. Newman, MD1, Daniel J. Bullard, MD1, Gaurav S. Suryawanshi, MD2, Ahmed Dirweesh, MD1, Guru Trikudanathan, MD1, Nabeel Azeem, MD1, Shawn Mallery, MD1, Martin L. Freeman, MD, MACG1, Stuart K. Amateau, MD, PhD, FACG1; 1University of Minnesota, Minneapolis, MN; 2University of Minnesota, Eden Prairie, MN
Introduction: Acute necrotizing pancreatitis (ANP) is a severe form of pancreatitis with significant morbidity and mortality. More patients are surviving index hospitalization with minimally invasive treatment approaches. The long-term outcomes in patients with ANP have not been well described. We investigated the success with outpatient interventions including cholecystectomy and chemical dependency treatment in relation to long-term outcomes of repeated hospitalization, alcohol use and mortality. Methods: Patients who were admitted to the University of Minnesota Medical Center from 2010 to 2019 and included in a prospectively collected database were screened to identify those with biliary or alcohol related ANP. Data on index hospitalization and patient characteristics was extracted using retrospective chart review. Long-term follow up and outpatient interventions were assessed with written and/or telephone surveys. Results: A total of 211 patients with alcohol (103/211, 48.8%) or biliary (108/211, 51.2%) ANP were identified after initial screening. Average age was 54.3 ± 15.2 years, 71% were male (150/211) and 14.2% deceased (30/211). There were a total of 67 responses to written or telephone surveys and the average length of follow up was 56 months. Cholecystectomy was reported by 95.6% (43/45) with biliary ANP, the remaining 4.4% (2/45) had met with a surgeon and were not surgical candidates. Only 11.6% (5/44) reported hospitalization in the prior year related to pancreatitis or related complications and 20.9% (9/43) reported frequent pain. Only 72.7% (16/22) with alcohol related ANP recalled having any provider discuss alcohol abstinence, 31.8% (7/22) reported completing any type of chemical dependency treatment and 40.9% (9/22) continued to drink alcohol. Although 9.1% (2/22) reported hospitalization in the past year, 31.8% (7/22) had ongoing pain related to their pancreas and only 50% (11/22) have followed up with a GI provider at the University of Minnesota. Discussion: Patients with biliary ANP are successful in following up for cholecystectomy. More attention needs to be drawn to those with alcohol related ANP acknowledging that up to 40% continue to drink with only a small proportion who have followed through with chemical dependency treatment. Particular emphasis should be placed prior to hospital discharge to educate patients on alcohol abstinence, encourage participation in chemical dependency treatment and schedule close follow up with a GI provider.
Disclosures: Krista Newman indicated no relevant financial relationships. Daniel Bullard indicated no relevant financial relationships. Gaurav Suryawanshi indicated no relevant financial relationships. Ahmed Dirweesh indicated no relevant financial relationships. Guru Trikudanathan indicated no relevant financial relationships. Nabeel Azeem indicated no relevant financial relationships. Shawn Mallery indicated no relevant financial relationships. Martin Freeman indicated no relevant financial relationships. Stuart Amateau: Boston Scientific – Consultant. Cook Medical – Consultant. Hemostasis – Consultant. Merit Medical – Consultant. Olympus – Consultant.