National Trends and Clinical Outcomes of Interventional Approaches Following Admission for Infected Necrotizing Pancreatitis in the United States.

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 DO if they received only percutaneous or endoscopic drainage, 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 to 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 to MIS. Hospitalization duration was longer (β: +12.1 days, 95% CI: 6.8-17.5) and costs were higher (β: +$58.7 K, 95% CI: 33.5-83.9) in Open compared to MIS.

CONCLUSIONS: Minimally invasive approaches for infected pancreatic necrosis has increased over time while open necrosectomy has declined. Open approaches compared to 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, IV.