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Morbid Obesity Linked to Higher Mortality in Pancreatitis, Bariatric Surgery Protective
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PHILADELPHIA — Two studies presented at the ACG Annual Scientific Meeting demonstrated associations between acute pancreatitis and both morbid obesity and a prior history of bariatric surgery.
“What we found was that morbid obesity with BMI over 40 increases your length of stay, increases your cost, increases your mortality and increases health care utilization,” Darwin L. Conwell, MD, department of gastroenterology, hepatology and nutrition, The Ohio State University Wexner Medical Center, told Healio.com/Gastroenterology. “Patients that had prior bariatric surgery had the exact opposite effect. If you had prior bariatric surgery and you developed acute pancreatitis, the bariatric surgery and the weight loss was protective. You had less cost associated with your hospitalization, less mortality, a shorter length of stay and it was protective.”
Darwin L. Conwell
Somashekar G. Krishna
Using data from the Nationwide Inpatient Sample, Conwell, Somashekar G. Krishna, MD, MPH, also from The Ohio State University Wexner Medical Center, and colleagues aimed to investigate the association between morbid obesity, bariatric surgery and acute pancreatitis. This dataset documents approximately 8 million discharges a year.
“Looking at very large databases will help us answer some of the clinical questions that we see every day in our gastroenterology practices,” Conwell said.
In-hospital, all-cause mortality served as the primary endpoints. Resource utilization, length of stay and total hospital charges served as secondary endpoints, along with presence of severe acute pancreatitis.
Morbid obesity
The researchers calculated for the probability of having morbid obesity for all patients. Adjustments were made for independent variables including demographics, hospital factors, etiology of acute pancreatitis and 27 other comorbidities.
The initial cohort included 1,278,005 weighted controls and 52,297 individuals with morbid obesity. Krishna and colleagues reduced the group to approximately 10,000 matched pairs.
“We saw an increasing prevalence of acute pancreatitis,” Krishna said during his presentation. “What’s more important is that there was a threefold increase in the prevalence of morbid obesity for all inpatients.”
Other findings indicated a nearly twofold increase in the presence of morbid obesity among patients discharged with acute pancreatitis.
“Acute pancreatitis-related mortality, while decreasing overall, remains unchanged in those with morbid obesity,” Krishna said.
Multivariate analysis results indicated an independent association between morbid obesity with mortality in acute pancreatitis (OR=1.58, P=.001). Morbid obesity was also associated with a longer length of stay and increased hospital charges.
Bariatric surgery
The aim of the second analysis was to determine the nature of the association between prior bariatric surgery and acute pancreatitis. Krishna and colleagues culled 1,328,348 controls — including 14,333 patients with a history of bariatric surgery — down to 2,826 matched pairs.
“Trend analysis … showed a twofold increase in bariatric surgery among all inpatient discharges. In parallel to this trend was increasing prevalence of prior bariatric surgery among those admitted with acute pancreatitis,” he said
Multivariate analysis results showed that patients with prior bariatric surgery underwent fewer ERCPs and needed more nonendoscopic biliary access and history of bariatric surgery was associated with a lower mortality risk (OR=0.42).
“This group also had a shorter hospital stay, incurred fewer hospital charges and had less incidence of acute respiratory failure,” Krishna said of the linear regression analysis.
For more information: Krishna SD. Abstracts 49, 50. Presented at: ACG Annual Scientific Meeting, Oct. 20-22, 2014; Philadelphia, PA.
Disclosures: Krishna reported no relevant financial disclosures.