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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Early versus delayed necrosectomy in pancreatic necrosis: A population-based cohort study on readmission, healthcare utilization, and in-hospital mortality
Hassam Ali, Faisal Inayat, Vinay Jahagirdar, Fouad Jaber, Arslan Afzal, Pratik Patel, Hamza Tahir, Muhammad Sajeel Anwar, Attiq Ur Rehman, Muhammad Sarfraz, Ahtshamullah Chaudhry, Gul Nawaz, Dushyant Singh Dahiya, Amir H Sohail, Muhammad Aziz
Hassam Ali, Arslan Afzal, Division of Gastroenterology and Hepatology, East Carolina University Brody School of Medicine, Greenville, NC 27834, United States
Faisal Inayat, Gul Nawaz, Department of Internal Medicine, Allama Iqbal Medical College, Lahore, Punjab 54550, Pakistan
Vinay Jahagirdar, Fouad Jaber, Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, United States
Pratik Patel, Division of Gastroenterology, Mather Hospital and Zucker School of Medicine at Hofstra University, Port Jefferson, NY 11777, United States
Hamza Tahir, Department of Internal Medicine, Jefferson Einstein Hospital, Philadelphia, PA 19141, United States
Muhammad Sajeel Anwar, Department of Internal Medicine, UHS Wilson Medical Center, Johnson City, NY 13790, United States
Attiq Ur Rehman, Muhammad Sarfraz, Division of Gastroenterology and Hepatology, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA 18711, United States
Ahtshamullah Chaudhry, Department of Internal Medicine, St. Dominic's Hospital, Jackson, MS 39216, United States
Dushyant Singh Dahiya, Division of Gastroenterology, Hepatology, and Motility, The University of Kansas School of Medicine, Kansas City, KS 66160, United States
Amir H Sohail, Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM 87106, United States
Muhammad Aziz, Division of Gastroenterology and Hepatology, The University of Toledo, Toledo, OH 43606, United States
Author contributions: Ali H, Inayat F, Jahagirdar V, Jaber F, Afzal A, Patel P, and Tahir M concepted and designed the study, participated in the acquisition of data, interpretation of results, writing of the original draft, and critical revisions of the important intellectual content of the final manuscript; Anwar MS, Rehman AU, Sarfraz M, Chaudhry A, Nawaz G, Dahiya DS, and Sohail AH contributed to the analysis and interpretation of results and drafting of the manuscript; Aziz A reviewed, revised, and improved the manuscript by suggesting pertinent modifications; and all authors critically assessed, edited, and approved the final manuscript and are accountable for all aspects of the work.
Institutional review board statement: The data of patients was not acquired from any specific institution but rather open-access United States National Readmission Database (NRD) database. The NRD contains de-identified information, protecting the privacy of patients, physicians, and hospitals. Therefore, this study was deemed exempt from the institutional review board.
Informed consent statement: Participants were not required to give informed consent for this retrospective cohort study since the analysis of baseline characteristics used anonymized clinical data.
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.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Faisal Inayat, MBBS, Research Scientist, Department of Internal Medicine, Allama Iqbal Medical College, Allama Shabbir Ahmad Usmani Road, Faisal Town, Lahore, Punjab 54550, Pakistan. faisalinayat@hotmail.com
Received: January 14, 2024
Revised: May 13, 2024
Accepted: May 27, 2024
Published online: September 20, 2024
Processing time: 162 Days and 11.8 Hours
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.
Core Tip: Clinical evidence regarding the impact of necrosectomy timing on patient outcomes and healthcare costs remains limited. Utilizing propensity-matched cohorts, this nationwide study evaluates the clinical and economic implications of early versus delayed necrosectomy in patients with pancreatic necrosis. Our findings show that early intervention within 48 hours is associated with lower rates of mechanical ventilation, septic shock, and in-hospital mortality. Early necrosectomy also results in substantial cost savings and shorter hospital stays. Intriguingly, the timing of the procedure does not significantly influence the 30-day readmission hazard ratio. These results contribute to the ongoing debate on the optimal timing of necrosectomy, offering evidence-based insights that could improve patient outcomes.
