2980 Obesity Does Not Increase Risk of Mortality in Necrotizing Pancreatitis

Abstract

INTRODUCTION: Obesity is considered an independent risk factor for increased severity of acute pancreatitis. However, the association of obesity with acute necrotizing pancreatitis and the impact on outcomes of necrotizing pancreatitis is sparsely described. Therefore, we aimed at impact of obesity on necrotizing pancreatitis in terms of inpatient mortality, length of stay and hospitalization charges. METHODS: This was a retrospective study utilizing the 2016 National Inpatient Database for all principal discharges of acute pancreatitis in obese patients more than 18 years of age utilizing ICD 10 codes. Primary outcomes were incidence of necrotizing pancreatitis in obese patients. Secondary outcomes were mortality, impact on healthcare utilization between the two cohorts. Multivariate analysis was utilized to adjust for confounders for evaluation of predictors of mortality. Poisson regression was performed for length of stay and hospitalization charges. RESULTS: Among total of 288,479 discharges with principal diagnoses of Acute Pancreatitis, 13.83% were associated with obesity. Acute necrotizing pancreatitis was associated with only 0.8% of the obese population with pancreatitis. There were no significant differences in terms of age, gender, ethnic differences in obese and normal BMI cohort. Acute kidney injury in necrotizing pancreatitis was more frequently observed in obese patients. There were no increased odds of mortality in obese patients with necrotizing pancreatitis as compared to patients with normal BMI after adjustment of confounders. Increasing age and male gender were significantly associated with increased odds of mortality in necrotizing patients. The length of stay was not significantly different in either of the cohorts (11.72 days vs 14.53 days). However, hospitalization charges were significantly higher in obese patients with necrotizing pancreatitis (27,867$ vs 44,113$, P 0.02). CONCLUSION: Even though obesity is an independent risk factor for severity of acute pancreatitis, incidence of obesity with necrosis was infrequent from a National Cohort. Acute kidney injury was more common in setting of obesity with necrosis which might explain the increased severity. However, obesity did not independently increase the odds of mortality in setting of necrotizing pancreatitis. Increasing age and male gender in setting of necrotizing pancreatitis leads to increased mortality. Further studies are warranted to elucidate the association of gender and necrotizing pancreatitis.