Prior bariatric surgery and better short-term outcomes in acute pancreatitis: a multicenter propensity-matched analysis

Khalid Ahmed; Abdellatif Ismail; Ayman Elawad; Mohammed Al-Aquily; Tarig Elhakim; Mohamed Abdallah; Ahmed Dirweesh

Authors Khalid Ahmed, Abdellatif Ismail, Ayman Elawad, Mohammed Al-Aquily, Tarig Elhakim, Mohamed Abdallah, Ahmed Dirweesh.

Abstract

Background Obesity is associated with an increased risk of severe acute pancreatitis (AP). Bariatric surgery is known to improve comorbidities and reduce systemic inflammatory burden. We aimed to evaluate whether a history of bariatric surgery is associated with differences in shortterm clinical outcomes among patients hospitalized with AP.

Methods Retrospective study using the TriNetX research network, including adults aged 18 years or older who were hospitalized with AP. Patients with chronic pancreatitis, pancreatic malignancy or cystic pancreatic disease were excluded. Study cohorts were defined based on the presence or absence of prior bariatric surgery performed at least 1 year before the AP admission. Cohorts were matched 1:1 using propensity scores. The primary outcome was 30-day all-cause mortality. Secondary outcomes were acute kidney injury (AKI), need for hemodialysis, endotracheal intubation, vasopressor use, elevations in inflammatory markers, and pancreatitis-related procedures, such as endoscopic retrograde cholangiopancreatography (ERCP) with stent placement, cholecystectomy, and pancreatic debridement.

Results After matching, both cohorts included 4024 patients. Bariatric patients had significantly lower 30-day mortality (1.9% vs. 2.6%; relative risk [RR] 0.71, 95% confidence interval [CI] 0.53-0.95; P=0.021), less AKI (0.8% vs. 1.5%; RR 0.54, 95%CI 0.35-0.82; P=0.003), and less hemodialysis (0.5% vs. 0.9%; RR 0.54, 95%CI 0.31-0.93; P=0.025). ERCP with stent placement was less frequent in the bariatric group (1.0% vs. 1.6%; RR 0.60, 95%CI 0.40-0.89; P=0.011). Other secondary outcomes did not differ significantly between groups.

Conclusions Bariatric surgery was associated with better short-term outcomes in AP. This included lower mortality and renal complications, possibly via metabolic and inflammatory effects.

Keywords Acute pancreatitis, bariatric, obesity, mortality

Ann Gastroenterol 2026; 39 (4): 446-451