Introduction: Acute necrotizing pancreatitis (ANP) is a severe condition requiring intensive care and complex, often multiple interventions. However, post-discharge outcomes have not been studied well. This prospective cohort study aimed to evaluate 90-day post-discharge outcomes, readmission rates, and predictors of readmission in patients with ANP.
Methods:
All consecutive patients hospitalized for ANP at our tertiary care centre were included and prospectively followed up after discharge. Patients were managed according to a predefined protocol. Their clinical course during index hospitalization and post-discharge clinical trajectory were periodically assessed. Patients were discharged if they were tolerating enteral nutrition, had no ongoing infection, pain, or symptomatic pancreatic fluid collection. The primary outcome was readmission rate, its timing and reasons for readmission. The secondary outcomes were the need for reintervention, duration of stay, and mortality.
Results:
A total of 206 patients (median age: 33 years [IQR: 26–44]; 75.2% male) were included. Gallstones(34.5%) and alcohol(32.0%) were the most common etiologies of AP. Moderately-severe and severe AP were seen in 61.6% and 38.3% of patients, respectively. Among patients with severe AP, acute respiratory failure(87.2%) followed by acute kidney injury(47.4%) were the most common organ failures.
During index admissions, 77 (37.4%) patients developed confirmed Infected necrosis with multi-drug resistant infections in 27.7% and invasive fungal infections in 12.6% of them. Following the step-up protocol, 57% required drainage (percutaneous 49% and endoscopic transluminal drainage in 8.3%) and of patients and 25.3 % required necrosectomy. Within 90 days post-discharge, 29.1% of patients were readmitted; 18.9% within 30 days (Early Readmission). Median time to readmission was 21 days (IQR: 12–43.5), with a median hospital stay of 13.5 days (IQR: 7–21.5) after readmission. Infected necrotizing pancreatitis was the leading cause in 67.3%, followed by symptomatic walled-off necrosis in 18.2%, and pancreatic bed hemorrhage in 7.3% of patients. The 90-day post-discharge mortality was 5.3%, with infected necrosis being the most common cause.
Conclusion:
Readmission following ANP was common, primarily due to ongoing smouldering sepsis in this interim analysis. Improved discharge planning and close follow-up in high-risk patients may reduce early rehospitalisations.