OUTCOMES AND MANAGEMENT OF ACUTE NECROTIZING PANCREATITIS DURING THE COVID-19 PANDEMIC

ABSTRACT

Introduction: The clinical care of patients with acute necrotizing pancreatitis (ANP) is resource-intensive. Patients with ANP often have severe illness which may require intensive care unit (ICU) admission, invasive drainage procedures, and other high-level multidisciplinary care. The Covid-19 pandemic has put an enormous strain on hospitals and ICUs around the world. The resulting impact of the pandemic, on the ability for hospitals to care for patients with ANP has not been studied. We aimed to analyze the outcomes and management of patients admitted with ANP before and during the pandemic using a large population dataset. Methods: TriNetX is a large international research network. This dataset comprises electronic health record (EHR)-derived disparate data from 57 healthcare networks and over 80,000,000 patient lives. We queried the dataset to find two cohorts of patients those admitted to a hospital with ANP from April 1, 2018-April 1, 2019, and those admitted to a hospital with ANP from April 1, 2020-April 1, 2021. The two cohorts were propensity matched using a 11 greedy nearest-neighbor algorithm based on age, sex, race, ethnicity, BMI, alcohol, and tobacco use. The primary outcome was 30-day all cause mortality. Secondary outcomes included rates of ICU admission, mechanical ventilation, antibiotic usage, endoscopic, and percutaneous drainage. Results: The incidences of ANP in the pre-Covid and post-Covid study years were 10.2 per 100,000 and 9.9 per 100,000 persons, respectively. The pre-Covid cohort contained 2,113 patients and the post-Covid cohort contained 2,083 patients. After matching, two cohorts of 1,943 remained (Table 1). In the post-Covid cohort, 29 patients (1.5%) tested positive for SARS-CoV-2 during the 30 days after hospital admission for ANP. Overall, there was no significant difference in the primary outcome of 30-day allcause mortality (4.4% vs 4.9%, p=0.49). Additionally, there were no significant differences in ICU admission, mechanical ventilation, endoscopic or percutaneous drainage, or antibiotic usage between the two groups. Conclusion: The Covid-19 pandemic has resulted in bed and staffing shortages both in ICU and general medical/surgical floors around the world. Despite this, the clinical management, and outcomes of patients with ANP did not significantly change for the worse compared with outcomes from 2018-2019. These data suggest that despite the strain induced by the Covid-19 pandemic, the care of patients with ANP, including those with critical care needs, was not compromised. (Table Presented)