Authors

Rachel Leah Choron, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
Charoo Piplani, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
Julia Kuzinar, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
Amanda L. Teichman, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
Christopher Bargoud, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
Jason D. Sciarretta, Emory University School of Medicine, Atlanta, GA
Randi N. Smith, Emory University School of Medicine, Atlanta, GA
Dustin Hanos, Grady Memorial Hospital Corp, Atlanta, GA
Iman N. Afif, Temple University Hospital, Philadelphia, PA
Jessica H. Beard, Temple University, Philadelphia, PA
Navpreet Kaur Dhillon, R Adams Cowley Shock Trauma Center, Baltimore, MA
Ashling Zhang, University of Maryland School of Medicine, Baltimore, MA
Mira Ghneim, R Adams Cowley Shock Trauma Center, Baltimore, MA
Rebekah Devasahayam, Vanderbilt University Medical Center, Nashville, TN
Oliver Gunter, Vanderbilt University School of Medicine, Nashville, TN
Alison A. Smith, LSU Health Sciences Center - New OrleansFollow
Brandi Sun, LSU Health Sciences Center - New OrleansFollow
Chloe S. Cao, University of Kentucky, Lexington, KY
Jessica K. Reynolds, University of Kentucky, Lexington, KY
Lauren A. Hilt, Medical College of Wisconsin, Milwaukee, WI
Daniel N. Holena, Medical College of Wisconsin, Milwaukee, WI
Grace Chang, Mount Sinai Hospital, Chicago, IL
Meghan Jonikas, Mount Sinai Hospital, Chicago, IL
Karla Echeverria-Rosario, Cooper University Hospital Regional Trauma Center, Camden, NJ
Nathaniel S. Fung, Riverside University Health System Medical Center, Moreno Valley, CA
Aaron Anderson, Indiana University Health Methodist Hospital, Indianapolis, IN
Caitlin A. Fitzgerald, The University of Texas Southwestern Medical Center, Dallas, TX
Ryan Peter Dumas, UT Southwestern Medical, Dallas, TX
Jeremy H. Levin, Indiana University Health Methodist Hospital, Indianapolis, IN
et al

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

Creative Commons Attribution-NonCommercial 4.0 International License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License

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