Complications of Necrotizing Pancreatic Requiring Drainage Device: A 5-Year National Inpatient Sample Analysis

Introduction: Necrotizing pancreatitis is associated with many serious complications and may in severe cases require a pancreatic drainage device. Drainage is often considered in patients with significant walled-off necrosis. The aim of this study is to assess the risk of inpatient complications in patients who have drainage devices placed for necrotizing pancreatitis by analyzing national data. Methods: This is a retrospective cohort study using National Inpatient Sample data including adults hospitalized between 2016 and 2020 with necrotizing pancreatitis. The primary outcomes measured were inpatient complications in patients requiring pancreatic drain placed endoscopically, percutaneously, or via an open approach compared to patients without a drain placed. Statistical analyses were all performed using STATA software (Table 1). Results: Of the 92,770 patients who presented with necrotizing pancreatitis, 6285 (7.3%) required a drain, 67.0% of patients were White and 66.9% were males, and mean age 54.5 versus 50.6 in the non-intervention group. Patients with pancreatic drains were at statistically significant (P< 0.05) increased risk for AKI (OR=1.349; 95% Cl 1.197-1.520), pulmonary embolism (OR=2.210; 95% Cl 1.638-2.979), pleural effusion (OR=1.871; 95% CI 1.649-2.122), respiratory failure (OR=1.579; 95% CI 1.384-1.802), pseudocyst (OR=5.775; 95% CI 5.103-6.5 36), post procedure hemorrhage (OR=5.154; 95% CI 1.365-19.461), shock (OR=2.169; 95% CI 1.872-2.512), sepsis (OR=2.043; 95% CI 1.815-2.300), and mortality (OR=1.286; 95% CI 1.014- 1.630). These patients were at increased risk for requiring blood transfusion (OR=2.076; 95% CI 1.732-2.487), mechanical ventilation (OR=1.607; 95% CI 1.379-1.873), and vasopressors (OR=2.132; 95% CI 1.669-2.722). Patients with pancreatic drains did not have a statistically significant risk (P >0.05) of ARDS, acute coronary syndrome (ACS), and stroke. Conclusion: Our data shows an increased risk of almost all complications in patients where drains were placed. Drain placement has an inherit risk of complications and may impact outcomes in this patient population. Our data likely also represents a component of increased severity of necrotizing pancreatitis in those requiring a drain along with the risk associated with the placement of the drain itself. Our study supports growing literature about the impact of drain placement in such patients, and we encourage providers to be judicious in selecting patients for drain placement. Table 1. - Patient demographics and hospitalization length of stay, cost, comorbidities, and complications in patients with pancreatic drainage devices placed versus not placed in patients with necrotizing pancreatitis Necrotizing pancreatitis with Intervention (n = 6285) Necrotizing pancreatitis without Intervention (n = 86485) P-value Demographics Mean Age, years 53.5 50.6 < 0.001 Gender, n Male Female 4205 (66.9%)1990 (31.7%) 55490 (64.2%)31075 (35.9%) 0.014 Race, n White Black Hispanic Asian or Pacific Islander Native American Other 4215 (67.1%)430 (6.8%)870 (13.8%)135 (2.1%)60 (1.0%)235 (3.7%) 55675 (64.4%)10505 (12.2%)11435 (13.2%)2470 (2.9%)950 (1.1%)2540 (2.9%) 0.022< 0.0010.2210.1570.7620.070 Charlson Comorbidity Index, n 0 1 2 3 4 5 or more 2165 (34.5%)1930 (30.7%)910 (14.5%)515 (8.2%)385 (6.1%)290 (4.6%) 29805 (34.5%)26225 (30.3%)13480 (15.6%)6915 (8.0%)4475 (5.2%)5675 (6.6%) 0.5450.6540.4350.7160.1310.007 Mean Length of Stay, days 23.4 11.3 < 0.001 Cost of Admission, dollars 300360.50 143430.60 < 0.001 Hospitalization Comorbidities and Complications ACS, n 65 (1.0%) 680 (0.8%) 0.376 AKI, n 2140 (34.1%) 24260 (28.1%) < 0.001 Stroke, n 50 (0.8%) 590 (0.7%) 0.628 Pulmonary Embolism, n 265 (4.2%) 1710 (2.0%) < 0.001 Pleural Effusion, n 1610 (25.6%) 13970 (16.2%) < 0.001 ARDS. n 105 (1.7%) 1550 (1.8%) 0.868 Respiratory Failure, n 1595 (25.4%) 15585 (18.0%) < 0.001 Pseudocyst, n 4110 (65.4%) 22130 (25.6%) < 0.001 Post Procedure Hemorrhage, n 15 (0.2%) 40 (0.1%) 0.007 Blood Transfusion, n 780 (12.4%) 5700 (6.6%) < 0.001 Shock, n 1165 (18.5%) 8460 (9.8%) < 0.001 Sepsis, n 2960 (47.1%) 26745 (30.9%) < 0.001 Mechanical Ventilation, n 1160 (18.5%) 10880 (12.6%) < 0.001 Vasopressors, n 400 (6.4%) 2720 (3.2%) < 0.001 Mortality, n 400 (6.4%) 4360 (5.0%) 0.037 Abbreviations: ACS, Acute Coronary Syndrome; AKI, Acute Kidney Injury; ARDS, Acute Respiratory Distress Syndrome.