Author:
Tran Zachary,Xu Jane,Verma Arjun,Ebrahimian Shayan,Cho Nam Yong,Benharash Peyman,Burruss Sigrid
Abstract
BACKGROUND
With recent studies demonstrating the efficacy of minimally invasive approaches following infected necrotizing pancreatitis, latest guideline recommendations support their use. However, large-scale studies are lacking, and the national landscape following these guidelines remains poorly characterized. The present study examined trends in intervention strategies and the association of approach on clinical outcomes and resource use in a nationally representative cohort.
METHODS
The 2016–2019 National Inpatient Sample was queried for adult hospitalizations for pancreatitis with infected necrosis. Patients were classified as drain only (DO) if they received only percutaneous or endoscopic drainage, minimally invasive (MIS) if they underwent endoscopic or laparoscopic debridement, and Open if they underwent open debridement. The primary outcome was in-hospital mortality, while secondary outcomes included perioperative complications, home discharge, and resource use. Multivariable regression models were developed to evaluate the association of intervention with clinical and financial endpoints.
RESULTS
Of 4,605 patients who received interventions, 1,735 (37.6%) were DO, 1,490 (32.4%) were MIS, and 1,380 (30.0%) were considered Open. The proportion of DO and MIS increased, while Open declined (2016, 47.0%; 2019, 24.6%; p < 0.001). Compared with Open, MIS had lower rates of abdominal compartment syndrome while having greater rates of preoperative closed drainage (31.9% vs. 13.8%, p < 0.001). After adjustment, odds of in-hospital mortality, respiratory failure, prolonged ventilation, and acute kidney injury were significantly higher in the Open cohort compared with MIS. Hospitalization duration was longer (β, +12.1 days; 95% confidence interval, 6.8–17.5), and costs were higher (β, +$58.7K; 95% confidence interval, 33.5–83.9) in Open compared with MIS.
CONCLUSION
Minimally invasive approaches for infected pancreatic necrosis have increased over time, while open necrosectomy has declined. Open approaches compared with drainage only or minimally invasive debridement were associated with greater odds of numerous in-hospital complications and resource burden.
LEVEL OF EVIDENCE
Prognostic and Epidemiological; Level IV.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Critical Care and Intensive Care Medicine,Surgery
Cited by
1 articles.
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