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. 2024 Sep 20;14(3):91810.
doi: 10.5662/wjm.v14.i3.91810.

Early versus delayed necrosectomy in pancreatic necrosis: A population-based cohort study on readmission, healthcare utilization, and in-hospital mortality

Hassam Ali  1 , Faisal Inayat  2 , Vinay Jahagirdar  3 , Fouad Jaber  3 , Arslan Afzal  1 , Pratik Patel  4 , Hamza Tahir  5 , Muhammad Sajeel Anwar  6 , Attiq Ur Rehman  7 , Muhammad Sarfraz  7 , Ahtshamullah Chaudhry  8 , Gul Nawaz  9 , Dushyant Singh Dahiya  10 , Amir H Sohail  11 , Muhammad Aziz  12
Affiliations

Early versus delayed necrosectomy in pancreatic necrosis: A population-based cohort study on readmission, healthcare utilization, and in-hospital mortality

Hassam Ali et al. World J Methodol. .

Abstract

Background: Acute necrotizing pancreatitis is a severe and life-threatening condition. It poses a considerable challenge for clinicians due to its complex nature and the high risk of complications. Several minimally invasive and open necrosectomy procedures have been developed. Despite advancements in treatment modalities, the optimal timing to perform necrosectomy lacks consensus.

Aim: To evaluate the impact of necrosectomy timing on patients with pancreatic necrosis in the United States.

Methods: A national retrospective cohort study was conducted using the 2016-2019 Nationwide Readmissions Database. Patients with non-elective admissions for pancreatic necrosis were identified. The participants were divided into two groups based on the necrosectomy timing: The early group received intervention within 48 hours, whereas the delayed group underwent the procedure after 48 hours. The various intervention techniques included endoscopic, percutaneous, or surgical necrosectomy. The major outcomes of interest were 30-day readmission rates, healthcare utilization, and inpatient mortality.

Results: A total of 1309 patients with pancreatic necrosis were included. After propensity score matching, 349 cases treated with early necrosectomy were matched to 375 controls who received delayed intervention. The early cohort had a 30-day readmission rate of 8.6% compared to 4.8% in the delayed cohort (P = 0.040). Early necrosectomy had lower rates of mechanical ventilation (2.9% vs 10.9%, P < 0.001), septic shock (8% vs 19.5%, P < 0.001), and in-hospital mortality (1.1% vs 4.3%, P = 0.01). Patients in the early intervention group incurred lower healthcare costs, with median total charges of $52202 compared to $147418 in the delayed group. Participants in the early cohort also had a relatively shorter median length of stay (6 vs 16 days, P < 0.001). The timing of necrosectomy did not significantly influence the risk of 30-day readmission, with a hazard ratio of 0.56 (95% confidence interval: 0.31-1.02, P = 0.06).

Conclusion: Our findings show that early necrosectomy is associated with better clinical outcomes and lower healthcare costs. Delayed intervention does not significantly alter the risk of 30-day readmission.

Keywords: Acute necrotizing pancreatitis; Delayed necrosectomy; Early necrosectomy; Mortality; Pancreatic necrosis; Readmission, Healthcare costs.

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Conflict of interest statement

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article. The preliminary form of these data was presented as an abstract at the Digestive Disease Week (DDW), May 19-21, 2024 in Washington, DC, United States.

Figures

Figure 1
Figure 1
Absolute rates of cause-specific 30-day readmission stratified by pancreatic necrosectomy timing on index admission in the matched cohort. A: Before 48 hours; B: After 48 hours.
Figure 2
Figure 2
The 30-day readmission risk based on pancreatic necrosectomy timing on index acute pancreatitis admission in the matched cohort (log rank = 0.07).
See this image and copyright information in PMC

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