S117 Impact of Tobacco and Nicotine Product Use on Outcomes in Acute Pancreatitis: A Retrospective Cohort Analysis

Introduction: Acute pancreatitis (AP) is a common gastrointestinal condition associated with significant morbidity and healthcare burden. While cigarette smoking has been linked to worse outcomes in pancreatitis, the role of other forms of nicotine exposure, such as vaping and smokeless tobacco, remains unclear. This study investigates the impact of exposure to these nicotinic products on AP outcomes, including mortality, ICU admission, necrotizing pancreatitis, and other complications such as shock and pancreatic cysts. Methods: We performed a retrospective analysis of the data, using the TriNetX U.S. Collaborative Network from 67 healthcare organizations. Four cohorts were defined based on nicotine exposure: AP-only patients (434,434), AP patients with cigarette use (AP-C) (83,623), AP patients with vaping (AP-V) (141), and AP patients with smokeless tobacco (AP-S) (5,251). We evaluated the key outcomes of the rates of mortality (M), ICU admission (I), shock (S), necrotizing pancreatitis (NP), pancreatic cyst formation (PC), and the need for pancreatic necrosectomy (PN). Results: AP (93,633) vs AP-C (93,633). S: OR 1.783, P < 0.0001, (higher in AP-C); M: OR 1.590, P < 0.0001, (higher in AP-C), PC: OR 1.197, P < 0.0001, (higher in AP-C), I: OR 0.343, P < 0.0001, (higher in AP), NP: OR 1.101, P < 0.0001, (higher in AP-C), PN: OR 1.858, P < 0.0001, (lower in AP-C). AP (5,218) vs AP-S (5,128): S: OR 1.923, P < 0.0001, (higher in AP-S), M: OR 1.786, P < 0.0001, (higher in AP-S), I: OR 0.233, P < 0.0001, (lower in AP-S), NP: OR 0.813, P = 0.027, (lower in AP-S). No significant differences observed for PC or PN. AP-C (4,804) vs AP-S (4,804): S: OR 1.224, P = 0.016, (higher in AP-S) M: OR 1.175, P = 0.004, (higher in AP-S), PC: OR = 1.283, P = 0.003, (higher in AP-C). I: OR = 1.768, P = 0.035, (higher in AP-C). No significant differences observed for NP or PN. AP-S (162) vs AP-V (162), AP-C (141) vs AP-V (141), and AP (168) vs AP-V (168). No statistically significant differences observed for NP, S, M, PC, I, or PN. Conclusion: This study highlights the varied associations between tobacco use and outcomes in acute pancreatitis (AP). As a retrospective study, this analysis can only identify associations and cannot establish causation. To our knowledge, this is the first study to report these associations between smokeless tobacco use and adverse outcomes in AP.