P2854 - Impact of Morbid Obesity on Hospitalizations for Pancreatic Necrosectomy

Tuesday, October 24, 2023

10:30 AM – 4:00 PM PT

Location: Exhibit Hall

Has Audio

Presenting Author(s)

DA

Daksh Ahluwalia, MD

John H. Stroger, Jr. Hospital of Cook County
Chicago, IL

Daksh Ahluwalia, MD¹, Bhanu Siva Mohan Pinnam, MD¹, Dushyant Singh. Dahiya, MD², Chun-Wei Pan, MD¹, Saman Tanveer, MD¹
¹John H. Stroger, Jr. Hospital of Cook County, Chicago, IL; ²University of Kansas School of Medicine, Kansas City, KS

Introduction: Acute pancreatitis is amongst the leading causes of gastroenterology admissions in the United States, associated with significant mortality and healthcare burden. A potentially fatal consequence of acute pancreatitis includes pancreatic necrosis (an indicator of severe pancreatitis), which is treated by drainage/debridement when infected, symptomatic or complicated. Review of literature demonstrated that obesity is a significant risk factor for adverse outcomes in acute pancreatitis. Our aim was to investigate the effect of morbid obesity on outcomes in patients with pancreatic necrosis undergoing necrosectomy.

Methods: A retrospective study was conducted using the National Inpatient Sample databases for the years 2016-2020. Using International Classification of Diseases, tenth revision (ICD-10 CM) along with ICD-10 Procedure Coding System (PCS) codes, we obtained a sample of admissions for pancreatic necrosis which underwent inpatient necrosectomy, further divided into two groups based on the presence of coexistent morbid obesity. Our primary outcome was to compare inpatient mortality between the two groups. Multivariate regression analysis was used to adjust for potential confounders.

Results: Our study demonstrated that morbid obesity was associated with approximately 90% higher odds of inpatient mortality after necrosectomy [aOR: 1.89 (95% CI: 1.16-3.06, p=0.01)]. The subgroup with morbid obesity also encountered greater length of hospitalization by 5 days, elevated odds of requiring ICU level of care, demonstrated by sepsis, increased pressor requirement, acute respiratory failure, and mechanical ventilation, along with complications such as myocardial infarction, acute kidney injury and blood transfusions.

Discussion: This study demonstrated that morbid obesity is an independent risk factor for mortality in patients undergoing pancreatic necrosectomy. Though obesity has been studied to be a primary risk factor for acute pancreatitis and its complications, such as necrosis and mortality; we suggest that the grade of obesity should be considered as a significant factor when risk stratifying of patients undergoing necrosectomy. Morbidly obese patients may require additional workup, closer monitoring, anticipation for elevation of level of care in order to improve outcomes.

Variable	Non morbidly obese	Morbidly obese	¶Adjusted odds ratio (95% CI)	p-value
Primary outcome
Mortality	3.45% (n=880)	5.66% (n=110)	1.89 (1.16 – 3.06)	0.01*
Secondary outcomes
LOS (in days)	14.30 (13.74-14.85)	19.08(16.92-21.24)	4.93 (2.63 – 7.23)	< 0.001*
THC adjusted for inflation (in USD)	193,229.8 (183438.7-203020.9)	289143.5 (245176.9 - 333110.0)	102128.8 (55311.19 – 148946.4)	< 0.001*
Sepsis	16.21% (n=4135)	27.51% (n=535)	2.03 (1.58 – 2.61)	< 0.001*
Myocardial infarction	0.57% (n=145)	1.8% (n=35)	3.29 (1.37 – 7.89)	< 0.001*
Intubation	8.11% (n=2070)	13.37% (n=260)	1.92 (1.39 – 2.66)	< 0.001*
Mechanical ventilation	10.05% (n=2565)	18.51% (n=360)	2.23 (1.66 – 2.99)	< 0.001*
Pressor requirement	2.29% (n=585)	4.37% (n=85)	2.19 (1.26 – 3.81)	0.006*
Acute respiratory failure	12.64% (n=3225)	20.57% (n=400)	1.88 (1.41 – 2.50)	< 0.001*
Blood transfusion	10.41% (n=2655)	14.14% (n=275)	1.39 (1.01 – 1.92)	0.045*
Acute kidney injury	21.63% (n=5520)	35.73% (n=695)	2.28 (1.79 – 2.91)	< 0.001*

Disclosures:

Daksh Ahluwalia indicated no relevant financial relationships.

Bhanu Siva Mohan Pinnam indicated no relevant financial relationships.

Dushyant Dahiya indicated no relevant financial relationships.

Chun-Wei Pan indicated no relevant financial relationships.

Saman Tanveer indicated no relevant financial relationships.

Daksh Ahluwalia, MD¹, Bhanu Siva Mohan Pinnam, MD¹, Dushyant Singh. Dahiya, MD², Chun-Wei Pan, MD¹, Saman Tanveer, MD¹. P2854 - Impact of Morbid Obesity on Hospitalizations for Pancreatic Necrosectomy, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.