S267 The Impact of Bariatric Surgery on Pancreatic Adenocarcinoma and Exocrine Pancreatic Insufficiency Risk in Patients With Chronic Pancreatitis and Morbid Obesity: A National Readmission Database Analysis

Introduction: Morbid obesity is associated with a higher incidence of chronic pancreatitis (CP). While bariatric surgery is known to reduce the risk of pancreatic adenocarcinoma (PAC) and exocrine pancreatic insufficiency (EPI) in patients with a healthy pancreas, its impact on those with preexisting CP is unclear. We aimed to evaluate whether prior bariatric surgery affects the risk of PAC and EPI in patients with CP and morbid obesity. Methods: Using the Nationwide Readmissions Database (2016 to 2022), adults with a diagnosis of CP and either morbid obesity or a history of bariatric surgery were identified. Demographics, comorbidities, and hospital factors were assessed. Univariate and multivariable logistic regressions were used to evaluate the association between prior bariatric surgery and 180-day outcomes of PAC and EPI. Results: A total of 28,026 patients with 31.5% having bariatric surgery. These patients were younger, more women, and had lower Charlson comorbidity scores. EPI occurred in 4.6% of the total cohort and PAC in 1.3%. EPI was more common in the bariatric surgery group (4.9% vs 4.4%, P < 0.001), while PAC rates were similar (1.2% vs 1.3%, P = 0.88). Multivariable analysis showed bariatric surgery was significantly associated with increased EPI risk (OR: 1.64; 95% CI: 1.18–2.27; P < 0.05), but not with PAC (odds ratio [OR]: 1.03; P = 0.73). No variables were associated with both increased risk of EPI and pancreatic cancer or decreased risk of each condition. Higher BMI was associated with reduced EPI risk (OR: 0.77 [0.66, 0.90], P < 0.05) as well as a nearly significant associated risk for patients with pancreatic cancer (OR: 0.95 [0.89, 1.01], P = 0.11). Conclusion: Contrary to its proven effectiveness in reducing pancreatic cancer risk in the general obese population; bariatric surgery's protective effect does not appear to extend to patients with chronic pancreatitis, and it should not be relied upon as a strategy for reducing PAC risk in CP. This highlights the need for alternative strategies and vigilant surveillance to manage cancer risk in this high-risk group. Similarly, these interventions should not be routinely recommended for patients with CP, particularly those exhibiting significant pancreatic dysfunction, as it may accelerate the progression to insufficiency and long-term complications.