P4329 - Contemporary Trends in the Management of Acute Necrotizing Pancreatitis: Changing Times?

Hoe Yan Hor, MBBS¹, Melody Pi Yin Tu, MBBS², Nabil Wasif, MD, MPH², Po Hong Tan, MBBS², Richard M. Miller, BS³, Dillon Cheung, MD², Stephanie Yu, MD², Arshia Pessaran, BS², Pei-Wen Lim, MD², Rahul Pannala, MD², James Madura, MD², Yu-Hui Chang, MS, PhD², Zhi Ven Fong, MD, MPH, DrPH²
1Mayo Clinic Arizona, Phoenix, AZ; 2Mayo Clinic, Phoenix, AZ; 3Creighton University School of Medicine, Phoenix, AZ

Introduction: Acute necrotizing pancreatitis (ANP) is often associated with prolonged hospitalization and high mortality rates. The contemporary treatment paradigm has shifted away from open necrosectomies and towards step-up strategies that incorporate minimally invasive (MIS) approaches. However, it is unclear if this has translated to actual practice changes in the real-world. This study aims to assess real-world practice patterns in the management of ANP.

Methods: The New York and Florida state databases were used to identify patients diagnosed with ANP between 2016 and 2021. Patients were categorized into treatment groups of an open necrosectomy-first approach or a step-up approach, defined as patients first undergoing an MIS procedure with either a percutaneous, endoscopic, or laparoscopic approach. Hierarchal regression models were used to adjust for measured confounding, with fixed effects assigned to patient-level variables and random effects assigned to hospital-level identifiers.

Results: We identified 1,180 patients with ANP; 104 (8.8%) underwent an open necrosectomy-first approach, whereas 1,076 (91.2%) underwent a step-up approach. Amongst those who underwent a step-up approach, only 18 patients (1.7%) eventually required an open necrosectomy after the initial MIS procedures. The proportion of patients who underwent an open necrosectomy-first approach steadily declined from 15.9% in 2016 to 6.3% in 2021, while the use of a step-up approach increased from 84.1% in 2016 to 93.7% in 2021 (p< 0.05, Figure 1). The median 1-year cumulative hospital charge was higher in the open necrosectomy-first group compared to the step-up group ($449,791 vs $338,679, p< 0.01). Patients in the open necrosectomy-first group had a longer median index hospital length-of-stay (LOS) compared to the step-up group (24.0 days vs 15.0 days, p=0.0006). Patients in the open necrosectomy-first group were also associated with a higher mortality rate compared to the step-up group (18.3% vs 10.2%, p=0.01). Both findings were consistent on regression models adjusting for confounders.

Discussion: While a step-up approach for ANP is increasingly utilized, almost 10% of patients still undergo upfront open necrosectomy in contemporary years. Patients with ANP who undergo upfront necrosectomy were associated with longer hospital LOS and higher mortality rates.


Figure: Figure 1: Overall Trend in the Use of Open Necrosectomy-first and Step-up Approach for Patients with Acute Necrotizing Pancreatitis from 2016 to 2021.

Disclosures:
Hoe Yan Hor indicated no relevant financial relationships.
Melody Pi Yin Tu indicated no relevant financial relationships.
Nabil Wasif indicated no relevant financial relationships.
Po Hong Tan indicated no relevant financial relationships.
Richard Miller indicated no relevant financial relationships.
Dillon Cheung indicated no relevant financial relationships.
Stephanie Yu indicated no relevant financial relationships.
Arshia Pessaran indicated no relevant financial relationships.
Pei-Wen Lim indicated no relevant financial relationships.
Rahul Pannala: HCL Technologies – Consultant. Nestlé Health Science – Consultant.
James Madura indicated no relevant financial relationships.
Yu-Hui Chang indicated no relevant financial relationships.
Zhi Ven Fong indicated no relevant financial relationships.

Hoe Yan Hor, MBBS¹, Melody Pi Yin Tu, MBBS², Nabil Wasif, MD, MPH², Po Hong Tan, MBBS², Richard M. Miller, BS³, Dillon Cheung, MD², Stephanie Yu, MD², Arshia Pessaran, BS², Pei-Wen Lim, MD², Rahul Pannala, MD², James Madura, MD², Yu-Hui Chang, MS, PhD², Zhi Ven Fong, MD, MPH, DrPH². P4329 - Contemporary Trends in the Management of Acute Necrotizing Pancreatitis: Changing Times?, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.