S173 Outcomes of Necrotizing Pancreatitis in Patients With Obesity: Insights From National Inpatient Sample

Introduction: Obesity is associated with higher risk of complications in patients with acute pancreatitis. Increased cytokine release, adipokine levels, and unsaturated fatty acid-mediated lipotoxicity have been hypothesized as mediators of inflammation in obese patients. Necrotizing pancreatitis (NP) accounts for 5%–10% of pancreatitis cases and is associated with increased morbidity and mortality compared to interstitial pancreatitis. However, the impact of body mass index on NP has not been well-characterized. Methods: We conducted a retrospective cohort study of patients with NP using the 2020 National Inpatient Sample database. Patients were categorized into 2 cohorts: NP with obesity and NP without obesity. We assessed outcomes including respiratory failure, portal vein thrombosis, and use of interventions such as mechanical ventilation, hemodialysis, open necrosectomy, endoscopic drainage, percutaneous drainage, laparoscopic drainage, length of stay, and in-hospital mortality. Multivariate regression analyses were used to compare outcomes after controlling for confounders such as sex, age, Charlson Comorbidity Index, household income, and insurance status. Results: Among 4,555 hospitalized NP patients, 3,390 (74.8%) comprised the obese cohort and 1,165 (25.2%) comprised the non-obese cohort. The obese cohort had significantly higher rates of acute hypoxic respiratory failure (20.05% vs 10.73%, adjusted odds ratio [aOR] 2.75, CI 1.65-4.60, P < 0.001), intubation (13.4% vs 7.29%, aOR 2.25, CI 1.26-4.01, P = 0.006), and hemodialysis (4.42% vs 1.29%, aOR 4.31, CI 1.28-14.67, P = 0.019). The non-obese cohort had significantly higher rates of portal vein thrombosis (10.73% vs 6.04%, aOR 0.52, CI 0.29-0.93, P = 0.027), open necrosectomy (6.14% vs 2.50%, aOR 0.47, CI 0.22-0.98, P = 0.045), and endoscopic drainage (6.08% vs 2.21%, aOR 0.29, CI 0.12-0.70, P = 0.006). Overall, length of stay (11.42 vs 10.68 days, P = 0.739) and in-hospital mortality (aOR 1.38, 95% CI 0.53-3.58, P = 0.502) did not differ significantly between cohorts. Conclusion: Our large database study suggests that obesity in NP patients is associated with severe extra-pancreatic manifestations while non-obese patients have higher odds of drainage procedures. Future studies should assess the reasons for increased need for drainage procedures in non-obese patients.