Descriptive Analysis of Patients Admitted with Necrotizing Pancreatitis: A Tertiary Care Center Experience

Abstract

Introduction: Necrotizing pancreatitis is a severe and sometimes fatal complication of acute pancreatitis causing high morbidity and mortality. Our aim was to assess the difference in Length of Stay (LOS), first intervention LOS and numbers of procedures according to primary diagnoses, surgery status and etiology. We also assessed the relationship between primary diagnoses, surgery status and the categorical outcomes infection, diabetes, bleeding, hernias, pancreatic enzyme use, fistulas, hemorrhage, admission to the ICU and multiple admissions. Methods: We analyzed all pancreatic pseudocyst and walled-off pancreatic necrosis patients who were admitted to our institution between November 2009 and October 2015. Due to a small sample size, we performed Wilcoxon Rank Sum and Kruskal-Wallis tests to assess the differences in initial Length of Stay (LOS) and first intervention (LOS) according to primary diagnoses and etiology. Among primary diagnoses and etiology groups, Chi Square and Fisher's Exact Tests were used to evaluate the differences in categorical outcomes including infection, diabetes, bleeding, hernias, pancreatic enzyme use, fistulas, hemorrhage, admission to the ICU and multiple admissions. Results: During the study period, 15 and 11 patients were admitted for pancreatic pseudocyst and walled-off pancreatic necrosis, respectively. The age mean for our study population was 50.31 years (13-74) with 58% male patients. Patients' etiology included alcohol (33.33%), gallstones (61.91%), and hypertriglyceridemia (4.76%). The number of infected patients was 11 (42.31%), while 19.23% of all patients experienced bleeding. A small number of patients had fistulas (n=3), diabetes (n=3), hemorrhage (n=1), pancreatic enzyme use (n=5) or hernias (n=1). Multiple admissions were reported for 17 patients (65.38%), while 9 patients (34.62) visited the ICU. In comparison to those with pancreatic pseudocyst, the mean initial LOS was 13 days higher among those with walled-off pancreatic necrosis primary diagnosis (Chi Square P=0.030) and (Fisher's Exact Test P=0.061). The status of pancreatic enzyme use was statistically different in relation to etiology (Chi Square P=0.026) (Fisher's Exact Test P=0.028). Infections were higher among patients with walled-off pancreatic necrosis (34.62%, P=0.051). Conclusion: This data will help in understanding the dynamics of a regional patient population as well as the performance of specific medical centers.