Necrotizing Pancreatitis Patients See Better Outcomes at High-Volume Centers

Nzenwa IC, Panoassian VS, DeWane MP, Albutt KH, et al. Volume Matters: Examining the Management of Necrotizing Pancreatitis in the United States. Ann Surg. June 2026.

This retrospective analysis evaluated the relationship between hospital case volume and clinical outcomes in patients admitted with necrotizing pancreatitis (NP).

Using data from the 2016–2019 Nationwide Readmissions Database, investigators identified 25,483 adult patients hospitalized with NP and categorized hospitals according to annual NP admission volume: low-volume (<9 cases/year), medium-volume (9–25 cases/year), and high-volume (≥26 cases/year).

Overall, 14.3% of patients underwent procedural intervention for NP. High-volume centers performed interventions more frequently and demonstrated greater adoption of minimally invasive and endoscopic approaches, whereas low- and medium-volume hospitals relied more heavily on traditional open necrosectomy and percutaneous drainage techniques. Although crude mortality rates among the overall NP population were highest at high-volume centers, these hospitals treated more clinically complex patients and achieved superior outcomes after risk adjustment.

Multivariable analysis demonstrated that treatment at high-volume hospitals was independently associated with significantly lower odds of in-hospital mortality for both the overall cohort and the subgroup requiring intervention. Among patients undergoing procedural management, mortality was substantially lower at high-volume centers compared with lower-volume institutions. In addition to improved survival, high-volume hospitals were associated with shorter lengths of stay and reduced health care expenditures.

These findings support the importance of experience and specialized multidisciplinary care in the management of necrotizing pancreatitis. High-volume centers appear more likely to implement contemporary, minimally invasive treatment strategies that may contribute to improved outcomes and resource utilization. The study highlights the potential value of regionalized care pathways and timely referral to specialized centers for patients with severe NP, particularly those requiring intervention.