Outcomes following operative vs. non-operative management of blunt traumatic pancreatic injuries: a retrospective multi-institutional study

Poppy Addison; Toni Iurcotta; Leo I Amodu; Geoffrey Crandall; Meredith Akerman; Daniel Galvin; Annemarie Glazer; Nathan Christopherson; Jose Prince; Matthew Bank; Christopher Sorrentino; Joaquin Cagliani; Jeffrey Nicastro; Gene Coppa; Ernesto P Molmenti; Horacio L Rodriguez Rilo

doi:10.1186/s41038-016-0065-5

Outcomes following operative vs. non-operative management of blunt traumatic pancreatic injuries: a retrospective multi-institutional study

Burns Trauma. 2016 Dec 9:4:39. doi: 10.1186/s41038-016-0065-5. eCollection 2016.

Authors

Poppy Addison^#^{1

2}, Toni Iurcotta^#^{1

2}, Leo I Amodu^{1

2}, Geoffrey Crandall¹, Meredith Akerman³, Daniel Galvin¹, Annemarie Glazer¹, Nathan Christopherson¹, Jose Prince¹, Matthew Bank¹, Christopher Sorrentino¹, Joaquin Cagliani², Jeffrey Nicastro^{1

2}, Gene Coppa^{1

2}, Ernesto P Molmenti^{1

2}, Horacio L Rodriguez Rilo^{1

2

4}

Affiliations

¹ Department of Surgery, Hofstra-Northwell School of Medicine, Hempstead, NY USA.
² Pancreas Disease Center, Northwell Health, Manhasset, NY USA.
³ Department of Biostatistics, Feinstein Institute for Medical Research, Manhasset, NY USA.
⁴ Northwell Health, 900 Northern Boulevard, Suite 150, Great Neck, NY 11020 USA.

^# Contributed equally.

Abstract

Background: Traumatic pancreatic injuries are rare, and guidelines specifying management are controversial and difficult to apply in the acute clinical setting. Due to sparse data on these injuries, we carried out a retrospective review to determine outcomes following surgical or non-surgical management of traumatic pancreatic injuries. We hypothesize a higher morbidity and mortality rate in patients treated surgically when compared to patients treated non-surgically.

Methods: We performed a retrospective review of data from four trauma centers in New York from 1990-2014, comparing patients who had blunt traumatic pancreatic injuries who were managed operatively to those managed non-operatively. We compared continuous variables using the Mann-Whitney U test and categorical variables using the chi-square and Fisher's exact tests. Univariate analysis was performed to determine the possible confounding factors associated with mortality in both treatment groups.

Results: Twenty nine patients were managed operatively and 32 non-operatively. There was a significant difference between the operative and non-operative groups in median age (37.0 vs. 16.2 years, P = 0.016), grade of pancreatic injury (grade I; 30.8 vs. 85.2%, P value for all comparisons <0.0001), median injury severity score (ISS) (16.0 vs. 4.0, P = 0.002), blood transfusion (55.2 vs. 15.6%, P = 0.0012), other abdominal injuries (79.3 vs. 38.7%, P = 0.0014), pelvic fractures (17.2 vs. 0.00%, P = 0.020), intensive care unit (ICU) admission (86.2 vs. 50.0%, P = 0.003), median length of stay (LOS) (16.0 vs. 4.0 days, P <0.0001), and mortality (27.6 vs. 3.1%, P = 0.010).

Conclusions: Patients with traumatic pancreatic injuries treated operatively were more severely injured and suffered greater complications than those treated non-operatively. The greater morbidity and mortality associated with these patients warrants further study to determine optimal triage strategies and which subset of patients is likely to benefit from surgery.

Keywords: Injury; Management; Non-operative; Operative; Pancreas; Trauma.