Document Type
Article
Publication Date
12-19-2024
Publication Title
Trauma Surgery & Acute Care Open
Abstract
INTRODUCTION: The utility of pancreaticoduodenectomy (PD) for high-grade traumatic injuries remains unclear and data surrounding its use are limited. We hypothesized that PD does not result in improved outcomes when compared with non-PD surgical management of grade IV-V pancreaticoduodenal injuries. METHODS: This is a retrospective, multicenter analysis from 35 level 1 trauma centers from January 2010 to December 2020. Included patients were ≥ 15 years of age with the American Association for the Surgery of Trauma grade IV-V duodenal and/or pancreatic injuries. The study compared operative repair strategy: PD versus non-PD. RESULTS: The sample (n=95) was young (26 years), male (82%), with predominantly penetrating injuries (76%). There was no difference in demographics, hemodynamics, or blood product requirement on presentation between PD (n=32) vs non-PD (n=63). Anatomically, PD patients had more grade V duodenal, grade V pancreatic, ampullary, and pancreatic ductal injuries compared with non-PD patients (all p < 0.05). 43% of all grade V duodenal injuries and 40% of all grade V pancreatic injuries were still managed with non-PD. One-third of non-PD duodenal injuries were managed with primary repair alone. PD patients had more gastrointestinal (GI)-related complications, longer intensive care unit length of stay (LOS), and longer hospital LOS compared with non-PD (all p < 0.05). There was no difference in mortality or readmission. Multivariable logistic regression analysis determined PD to be associated with a 3.8-fold greater odds of GI complication (p=0.010) compared with non-PD. In a subanalysis of patients without ampullary injuries (n=60), PD patients had more anastomotic leaks compared with the non-PD group (3 (30%) vs 2 (4%), p=0.028). CONCLUSION: While PD patients did not have worse hemodynamics or blood product requirements on admission, they sustained more complex anatomic injuries and had more GI complications and longer LOS than non-PD patients. We suggest that the role of PD should be limited to cases of massive destruction of the pancreatic head and ampullary complex, given the likely procedure-related morbidity and adverse outcomes when compared with non-PD management. LEVEL OF EVIDENCE: IV, Multicenter retrospective comparative study.
First Page
e001438
PubMed ID
39717488
Volume
9
Issue
1
Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License
Recommended Citation
Choron, Rachel Leah; Piplani, Charoo; Kuzinar, Julia; Teichman, Amanda L.; Bargoud, Christopher; Sciarretta, Jason D.; Smith, Randi N.; Hanos, Dustin; Afif, Iman N.; Beard, Jessica H.; Dhillon, Navpreet Kaur; Zhang, Ashling; Ghneim, Mira; Devasahayam, Rebekah; Gunter, Oliver; Smith, Alison A.; Sun, Brandi; Cao, Chloe S.; Reynolds, Jessica K.; Hilt, Lauren A.; Holena, Daniel N.; Chang, Grace; Jonikas, Meghan; Echeverria-Rosario, Karla; Fung, Nathaniel S.; Anderson, Aaron; Fitzgerald, Caitlin A.; Dumas, Ryan Peter; Levin, Jeremy H.; and al, et, "Pancreaticoduodenectomy in trauma patients with grade IV-V duodenal or pancreatic injuries: a post hoc analysis of an EAST multicenter trial" (2024). School of Medicine Faculty Publications. 3409.
https://digitalscholar.lsuhsc.edu/som_facpubs/3409
10.1136/tsaco-2024-001438
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Digestive System Commons, Surgical Procedures, Operative Commons, Wounds and Injuries Commons