S9 Impact of Pancreatic Divisum on Inpatient Outcomes in Pancreatitis: A Nationwide Analysis

Introduction: Pancreatic divisum (PD) is the most common congenital anomaly of the pancreatic ductal system, occurring in up to 10% of the population. While most patients with PD are asymptomatic, it has been implicated as a potential risk factor for recurrent or idiopathic pancreatitis. We sought to evaluate whether patients admitted for management of pancreatitis secondary to PD had disparate outcomes compared to those without. Methods: We analyzed 5-year data from the National Inpatient Sample from 2018 to 2022 to identify adult hospitalizations with a primary diagnosis of acute or chronic pancreatitis using relevant ICD-10 codes. PD was identified in the secondary diagnosis field. In-hospital mortality, length of stay, total hospital charges, and intensive care unit (ICU) utilization were outcomes of interest. Results: Among an estimated 366,053 weighted pancreatitis admissions, 0.48% had a secondary diagnosis of coexisting pancreatic divisum. Compared to non-PD cases, PD patients were younger (mean age 49.9 vs 50.9) and had a lower prevalence of alcohol use (11.8% vs 33.6%), gallstones (5.8% vs 15.3%), and obesity (15.3% vs 19.1%), all P < 0.001. When adjusted for confounders, PD was associated with increased length of stay (+0.67 days, P < 0.001) and higher total charges (+$6,479, P = 0.004) but showed no significant difference in in-hospital mortality (adjusted odds ratio 0.40, P = 0.083) or ICU use (adjusted odds ratio 0.60, P = 0.052). Conclusion: In this large cohort study, PD was found to account for a small subset of patients with pancreatitis. Although these patients experienced longer hospital stays and higher procedural costs, pancreatic divisum was not associated with poorer short-term outcomes, although there was a trend toward significance, particularly with respect to ICU use. The higher costs and extended hospital stays were likely a result of the more extensive diagnostic workups, performed to rule out other causes prior to determining PD as the primary etiology.