In the Journals

Bariatric surgery not linked to adverse clinical outcomes in patients with acute pancreatitis

Researchers did not observe adverse associations between prior bariatric surgery and in-hospital mortality, development of organ failure or an escalation of health care resource use in patients hospitalized with acute pancreatitis, according to the results of a retrospective study.

Moreover, bariatric surgery may lessen adverse effects of obesity related to acute pancreatitis.

“Bariatric surgery may mitigate the obesity-associated adverse prognostication in [acute pancreatitis]. These observations are pertinent for future research, since the prevalence of obesity and AP-related hospitalizations are increasing,” Somashekar G. Krishna, MD, MPH, of the section of pancreatic disorders, division of gastroenterology, hepatology and nutrition at The Ohio State University Wexner Medical Center, and colleagues wrote.

Somashekar G. Krishna

Krishna and colleagues evaluated 2007-2011 data from the US Nationwide Inpatient Sample on 1,342,681 inpatient adults with AP. Among all patients with a principal diagnosis of AP admitted to the hospital, 14,332 (1.07%) had previously undergone bariatric surgery. The researchers compared clinical and secondary outcomes in patients who underwent bariatric surgery with those who had not undergone bariatric surgery using a propensity-score matched analysis.

Between 2007 and 2011, the number of patients who underwent bariatric surgery doubled from 1,801 to 3,928 (P < .001). 

Gallstones were most frequently associated with AP in patients who had undergone bariatric surgery. Multivariate analyses revealed associations between prior bariatric surgery and a decrease in mortality (OR = 0.41; 95% CI, 0.18–0.92), an average of 0.65 day shorter length of hospital stay (P < .001), and an average $3,558 lower hospital charges (P < .001).

Furthermore, the propensity-score matched cohort analysis showed mortality and odds for acute kidney injury were similar between surgery and non-surgery groups. In patients who underwent bariatric surgery, respiratory failure occurred less often than in patients without bariatric surgery (1.34% vs 4.42%; P < .001).

“Amongst hospitalized patients with AP, prior [bariatric surgery] is neither associated with adverse clinical outcomes nor escalating healthcare resources. Conversely, obesity is adversely associated with each of these primary and secondary outcomes,” the researchers concluded. “The contrast of the unfavorable impact of morbid obesity against the favorable influence of prior-[bariatric surgery] raises the tantalizing hypothesis that [bariatric surgery] may mitigate or reverse the adverse effects of obesity related to AP. Further exploration of this hypothesis in a prospective cohort may provide additional insights into the mechanisms of obesity in the pathogenesis of acute pancreatitis.” – by Suzanne Reist

Disclosures: The researchers report no relevant financial disclosures.

Researchers did not observe adverse associations between prior bariatric surgery and in-hospital mortality, development of organ failure or an escalation of health care resource use in patients hospitalized with acute pancreatitis, according to the results of a retrospective study.

Moreover, bariatric surgery may lessen adverse effects of obesity related to acute pancreatitis.

“Bariatric surgery may mitigate the obesity-associated adverse prognostication in [acute pancreatitis]. These observations are pertinent for future research, since the prevalence of obesity and AP-related hospitalizations are increasing,” Somashekar G. Krishna, MD, MPH, of the section of pancreatic disorders, division of gastroenterology, hepatology and nutrition at The Ohio State University Wexner Medical Center, and colleagues wrote.

Somashekar G. Krishna

Krishna and colleagues evaluated 2007-2011 data from the US Nationwide Inpatient Sample on 1,342,681 inpatient adults with AP. Among all patients with a principal diagnosis of AP admitted to the hospital, 14,332 (1.07%) had previously undergone bariatric surgery. The researchers compared clinical and secondary outcomes in patients who underwent bariatric surgery with those who had not undergone bariatric surgery using a propensity-score matched analysis.

Between 2007 and 2011, the number of patients who underwent bariatric surgery doubled from 1,801 to 3,928 (P < .001). 

Gallstones were most frequently associated with AP in patients who had undergone bariatric surgery. Multivariate analyses revealed associations between prior bariatric surgery and a decrease in mortality (OR = 0.41; 95% CI, 0.18–0.92), an average of 0.65 day shorter length of hospital stay (P < .001), and an average $3,558 lower hospital charges (P < .001).

Furthermore, the propensity-score matched cohort analysis showed mortality and odds for acute kidney injury were similar between surgery and non-surgery groups. In patients who underwent bariatric surgery, respiratory failure occurred less often than in patients without bariatric surgery (1.34% vs 4.42%; P < .001).

“Amongst hospitalized patients with AP, prior [bariatric surgery] is neither associated with adverse clinical outcomes nor escalating healthcare resources. Conversely, obesity is adversely associated with each of these primary and secondary outcomes,” the researchers concluded. “The contrast of the unfavorable impact of morbid obesity against the favorable influence of prior-[bariatric surgery] raises the tantalizing hypothesis that [bariatric surgery] may mitigate or reverse the adverse effects of obesity related to AP. Further exploration of this hypothesis in a prospective cohort may provide additional insights into the mechanisms of obesity in the pathogenesis of acute pancreatitis.” – by Suzanne Reist

Disclosures: The researchers report no relevant financial disclosures.