Prevalence and Outcomes of Local Complications in Acute Pancreatitis: A Review of Nationwide Inpatient Data

Introduction: Acute pancreatitis (AP) remains a common indication for hospitalization in the digestive disease category. Local complications such as pseudocysts, pancreatic necrosis, and portal vein thrombosis might contribute to mortality and morbidity related to AP. The purpose of our study was to measure the rates of local complications related to AP and assess their impact on the health care outcomes. Methods: We used the nationwide inpatient sample database (NIS) from 2016-2017 for this study. International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes for AP, AP with complications (necrosis with and without infection, pseudocyst, portal vein thrombosis, abdominal compartment syndrome) were obtained. Cox-proportional hazards regression model was used to estimate the in-hospital mortality associated with AP with and without complications, while accounting for competing events. Adjusted hazard ratios (HR) and confidence intervals (CI) at 99% were reported. Results: The total number of patients with a diagnosis of AP was 201,891; with 25,515 (13%) having local complications related to AP. The odds of in-hospital mortality were significantly higher in AP patients with local complications compared to those without (8.4% vs 2.0%, p< 0.001). In the regression analysis, the risk of in-hospital mortality in patients with AP with complications was 3.62 times higher than in those without complications, adjusted HR 3.62, 99% CI: 3.41 – 3.83 (Table). In the subgroup analysis, there was no difference in in-hospital mortality in patients with a pancreatic pseudocyst (adjusted HR 1.16, 99% CI: 0.98 – 1.38). In-hospital mortality remained high in patients with pancreatic necrosis (adjusted HR 2.37, 99% CI: 2.05 – 2.75), portal vein thrombosis (adjusted HR 3.57, 99% CI: 3.34 – 3.82) and abdominal compartment syndrome (adjusted HR 20.64, 99% CI: 18.67 – 22.81). Length of stay on average was 3 days higher in patients with AP who had complications (p< 0.001) and the hospitalization related cost was higher in this group as well (greater than $54,000, p< 0.001). Conclusion: Local complications such as pseudocysts, pancreatic necrosis, and portal vein thrombosis occur in a sizeable number of patients with AP. These complications appear to be a major factor contributing to mortality and an increase in the utilization of health care resources in AP. Early detection and timely management of local complications in AP will likely improve health-related outcomes.Table 1.: Title: Predictors of in-hospital outcomes.