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

被引:9
作者
Addison, Poppy [1 ,2 ]
Iurcotta, Toni [1 ,2 ]
Amodu, Leo I. [1 ,2 ]
Crandall, Geoffrey [1 ]
Akerman, Meredith [3 ]
Galvin, Daniel [1 ]
Glazer, Annemarie [1 ]
Christopherson, Nathan [1 ]
Prince, Jose [1 ]
Bank, Matthew [1 ]
Sorrentino, Christopher [1 ]
Cagliani, Joaquin [2 ]
Nicastro, Jeffrey [1 ,2 ]
Coppa, Gene [1 ,2 ]
Molmenti, Ernesto P. [1 ,2 ]
Rilo, Horacio L. Rodriguez [1 ,2 ,4 ]
机构
[1] Hofstra Northwell Sch Med, Dept Surg, Hempstead, NY 11549 USA
[2] Northwell Hlth, Pancreas Dis Ctr, Manhasset, NY USA
[3] Feinstein Inst Med Res, Dept Biostat, Manhasset, NY USA
[4] Northwell Hlth, 900 Northern Blvd,Suite 150, Great Neck, NY 11020 USA
关键词
Injury; Management; Non-operative; Operative; Pancreas; Trauma; ABDOMINAL-TRAUMA; TRANSFUSION; DIAGNOSIS; PREDICTORS; INFECTION; ALGORITHM; CHILDREN; AMYLASE; IMPACT;
D O I
10.1186/s41038-016-0065-5
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
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.
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页数:7
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