S116 Too Much, Too Soon? Rethinking Fluid Resuscitation in Acute Pancreatitis: A Retrospective Cohort Study

Introduction: Early fluid resuscitation is the cornerstone of management for acute pancreatitis (AP), yet the optimal volume and approach remain under debate, especially when it comes to differing severities of AP. While early aggressive resuscitation has been standard practice for years, emerging evidence suggests potential harm in certain patient populations. This study explores how the amount and timing of fluid resuscitation can impact clinical outcomes for varying severities of AP. Methods: A retrospective analysis of patients diagnosed with AP who were admitted to a large academic medical center from January 2023-November 2024 was conducted. Patients were stratified by disease severity (mild-moderate vs severe) using severity scores and resuscitation strategy (bolus and continuous - moderate vs aggressive, and timing - early vs moderately-late vs late). Univariate and bivariate analyses were conducted using chi-square and one-way ANOVA. Primary outcomes included mortality, hospital length of stay (LOS), and Intensive Care Unit (ICU) admission rate/LOS. Results: 209 patients were included (mean ± SD age, 46 ± 17 years), with 82% having mild-moderate pancreatitis. Etiologies of AP included gallstone (37.3%), followed by alcohol (22.0%), and hypertriglyceridemia (6.7%). There were no differences in mortality amongst the different severities of AP regardless of fluid resuscitation strategy (bolus, P = 0.143, continuous, P = 0.793). Post-hoc comparisons in severe AP patients revealed no statistically significant differences in hospital stay (P = 0.95) or ICU length of stay (P = 0.84) regardless of bolus resuscitation strategy. Similarly, in mild-moderate AP patients, there were no statistically significant differences in hospital LOS (P = 1.0) or ICU LOS (P = 0.4), regardless of bolus resuscitation strategy. The hospital and ICU LOS were not significantly extended in either the mild-moderate or severe AP patients, regardless of the timing of fluid resuscitation (P > 0.05). Fluid overload within 24 and 48 hours of admission were not seen in any severity of AP, regardless of timing of fluid resuscitation or rate (P > 0.05). Conclusion: Despite differing fluid resuscitation strategies, there was no optimal fluid resuscitation strategy that led to the improvements in clinical outcomes (mortality, hospital LOS, ICU LOS, fluid overload), regardless of AP severity. Further studies with larger sample sizes are needed to determine an optimal fluid resuscitation strategy based on AP severity.