• Ikemsinachi C Nzenwa, Vahe S Panossian, Michael P DeWane, Katherine H Albutt, Yasmin G Hernandez-Barco, Carlos F Fernandez-Del Castillo, Keith D Lillemoe, Andrew L Warshaw, Peter J Fagenholz, and Casey M Luckhurst.
• Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA.
• Ann. Surg. 2025 Feb 4.

ObjectiveTo examine the impact of hospital volume on mortality and healthcare utilization in patients admitted with necrotizing pancreatitis (NP).BackgroundOver 20% of patients with acute pancreatitis develop NP, which has been associated with higher rates of procedural intervention, morbidity, and mortality.MethodsAdult patients admitted with NP were identified in the 2016-2019 Nationwide Readmissions Database 2016-2019. Hospital volume cutoffs were defined by tertiles of total NP admissions per year (low-volume [<9 admissions/year]; medium-volume [9-25 admissions/year]; high-volume [≥26 admissions/year]). Subgroup analyses were performed for NP patients undergoing procedural intervention. The primary outcome was in-hospital mortality. Multivariable logistic regression models determined the association between clinical outcomes and hospital volume.ResultsA total of 25,483 patients were identified, 14.3% of whom underwent procedural intervention, with the highest rate of intervention occurring in high-volume hospitals. The most common interventions offered at low- and medium-volume hospitals were open necrosectomy and percutaneous drainage. In contrast, high-volume hospitals had increased rates of minimally invasive surgery and endoscopic management. High-volume centers had the highest mortality rate among all patients (7.3% vs. 6.6% vs. 5.5%, P<0.001) but the lowest among the intervention-only cohort (7.5% vs. 10.4% vs. 12.0%, P<0.001). After adjusting for confounders, high-volume centers had lower odds of mortality in all patients (odds ratio (OR) 0.78, 95% confidence interval (CI) 0.65-0.93) and in the intervention-only cohort (OR 0.64, 95% CI 0.42-0.96). High-volume hospitals were also associated with a shorter hospital stay and lower healthcare costs.ConclusionManagement of NP at high-volume hospitals was associated with improved survival and decreased healthcare utilization. As interventional techniques advance, following evidence-based guidelines and implementing clear referral pathways will optimize outcomes for both patients and hospital systems.Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.

13 keywords...

hide…