Prognostic Factors and Outcomes of Nonoperative Versus Operative Management in Adult and Pediatric Patients Following Pancreatic Trauma: A Systematic Review

J Surg Res. 2025 Nov:315:93-105. doi: 10.1016/j.jss.2025.09.012. Epub 2025 Sep 30.

Abstract

Introduction: This systematic review aims to evaluate prognostic factors of poor outcomes and compare clinical outcomes between nonoperative management (NOM) and operative management in adult or pediatric pancreatic trauma patients.

Methods: A systematic review of five databases was conducted through May 6, 2025. Studies assessing pancreatic trauma patients, identifying prognostic factors, or comparing operative versus NOM were included. Outcomes of interest included in-hospital mortality, in-hospital complications, and intensive care unit length of stay.

Results: Sixteen studies met the inclusion criteria and analyzed over 14,000 patients. Prognostic factors associated with increased mortality included shock (odds ratio: 3.31, 95% confidence interval: 1.16-9.42, 0.022) and sepsis (odds ratio: 43.47, 95% confidence interval: 4.15-455.75, P = 0.002). In addition, high-grade injuries (American Association for the Surgery of Trauma ≥ 3) resulted in increased NOM failure (P = 0.0169) in pediatric patients. There were no differences in mortality between management approaches, regardless of injury grade, type, or age group. NOM resulted in increased rates of pancreatic complications, including pseudocysts, in patients with blunt trauma (37.5% versus 5.2%, P < 0.001) and in pediatric patients with high-grade injuries (44% versus 0%, P < 0.001). No significant differences were noted between resection and nonresection procedures, although resection resulted in reduced complications for higher grade trauma in adult and pediatric patients (33% versus 77%, P = 0.01).

Conclusions: Prognostic factors such as increased injury severity were associated with higher rates of mortality and nonoperative failure. NOM demonstrated increased complications in adult and pediatric patients with high-grade blunt pancreatic trauma. Patients with high-grade pancreatic injuries treated with pancreatic resection showed improved outcomes, which demonstrates the safety of pancreatic resection in these patient populations.

Keywords: Adult; Injury grade; Injury type; Non-operative management; Operative management; Pancreatic trauma; Pediatric; Prognostic factors.

Publication types

  • Comparative Study
  • Systematic Review

MeSH terms

  • Abdominal Injuries* / complications
  • Abdominal Injuries* / diagnosis
  • Abdominal Injuries* / mortality
  • Abdominal Injuries* / therapy
  • Adult
  • Child
  • Conservative Treatment* / adverse effects
  • Conservative Treatment* / methods
  • Conservative Treatment* / statistics & numerical data
  • Hospital Mortality
  • Humans
  • Length of Stay / statistics & numerical data
  • Pancreas* / injuries
  • Pancreas* / surgery
  • Postoperative Complications* / epidemiology
  • Postoperative Complications* / etiology
  • Prognosis
  • Treatment Outcome
  • Wounds, Nonpenetrating* / complications
  • Wounds, Nonpenetrating* / mortality
  • Wounds, Nonpenetrating* / therapy