Abstract
BackgroundWalled-off pancreatic necrosis (WOPN) represents an encapsulated collection of necrotic pancreatic or peripancreatic tissue that tends to develop four weeks after the onset of acute necrotizing pancreatitis. When infected, it is managed initially by antibiotic therapy before drainage by endoscopic, percutaneous, or surgical means. This study aims to describe the morbidity, mortality, length of stay (LOS), and cost of care associated with open surgical, laparoscopic, and radiology-guided percutaneous drainage in adult patients with infected WOPN.MethodsUsing the Nationwide Inpatient Sample (NIS), patients aged 18 years and older discharged with the diagnosis of WOPN between January 1, 2016 and December 31, 2016 who underwent open, laparoscopic, or percutaneous drainage were included. Patients’ characteristics including age, gender, and body mass index were reported. The primary endpoints were the mortality rate as well as length and cost of stay in each group. The secondary endpoint was the rate of procedural complications in each arm. Endpoints were reported and compared with studies assessing similar outcomes. Statistical Analysis System (SAS) statistical software (SAS Institute Inc., Cary, NC, USA) was used to perform the analysis.ResultsA total of 229 patients with the diagnosis of acute pancreatitis with infected necrosis were identified. Of these 229 patients, 27, 15, and 20 underwent open, laparoscopic, and percutaneous drainage, respectively. A total of eight studies were used for comparison of outcome variables. Mortality rate was found to be similar among comparison studies. LOS and costs varied widely among studies. There were significantly fewer pancreatic fistula and significantly more multi-organ failure complications as a result of open necrosectomy in the NIS study sample.ConclusionOverall, in analyzing the outcomes of patients undergoing intervention for infected WOPN through the 2016 NIS database, it appears that the database is representative of the majority of outcomes seen in similar clinical trials.
Highlights
Acute pancreatitis (AP) accounts for over 275,000 hospital admissions in the United States, totaling healthcare costs that surpass 2.5 billion US dollars each year [1]
Data pulled from the Nationwide Inpatient Sample (NIS) 2016 showed that patients undergoing radiology-guided percutaneous drainage for Walled-off pancreatic necrosis (WOPN) were found to have a median length of hospital stay of 22 days, those undergoing laparoscopic drainage had a median length of stay (LOS) of 31 days, and those undergoing open necrosectomy had a median LOS of 42 days (Table 3)
LOS for those undergoing open necrosectomy ranged from 42 to 91 days and those undergoing minimally invasive surgery (MIS)/SUA ranged from 22 to 101 days, with the NIS sample accounting for the lowest LOS in both cases
Summary
Acute pancreatitis (AP) accounts for over 275,000 hospital admissions in the United States, totaling healthcare costs that surpass 2.5 billion US dollars each year [1]. Necrotizing pancreatitis is an encompassing term that includes both early-stage acute necrotic collection (ANC) as well as later stage WOPN. The latter represents an encapsulated collection of necrotic pancreatic or peripancreatic tissue that develops usually more than four weeks after the onset of acute necrotizing pancreatitis. Walled-off pancreatic necrosis (WOPN) represents an encapsulated collection of necrotic pancreatic or peripancreatic tissue that tends to develop four weeks after the onset of acute necrotizing pancreatitis. When infected, it is managed initially by antibiotic therapy before drainage by endoscopic, percutaneous, or surgical means. This study aims to describe the morbidity, mortality, length of stay (LOS), and cost of care associated with open surgical, laparoscopic, and radiology-guided percutaneous drainage in adult patients with infected WOPN
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