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Management of pancreatic injuries during damage control surgery: an observational outcomes analysis of 79 patients treated at an academic Level 1 trauma centre

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Abstract

Background

This study evaluated factors influencing mortality in a large cohort of patients who sustained pancreatic injuries and underwent DCS.

Methods

A prospective database of consecutive patients with pancreatic injuries treated at a Level 1 academic trauma centre was reviewed to identify those who underwent DCS between 1995 and 2014.

Results

Seventy-nine (71 men, median age: 26 years, range 16–73 years, gunshot wounds = 62, blunt = 14, stab = 3) patients with pancreatic injuries (35 proximal, 44 distal) had DCS. Fifty-nine (74.7 %) patients had AAST grade 3, 4 or 5 pancreatic injuries. The 79 patients had a total of 327 associated injuries (mean: 3 per patient, range 0–6) and underwent a total of 187 (range 1–7) operations. Vascular injuries (60/327, 18.3 %) occurred in 41 patients. Twenty-seven (34.2 %) patients died without having a second operation. The remaining 52 patients had two or more laparotomies (range 2–7). Overall 28 (35 %) patients underwent a pancreatic resection either during DCS (n = 18) or subsequently as a secondary procedure (n = 10) including a Whipple (n = 6) when stable. Overall 43 (54.4 %) patients died. Mortality was related to associated vascular injuries overall (p < 0.01), major visceral venous injuries (p < 0.01) and combined vascular and total number of associated organs injured (p < 0.04).

Conclusions

Despite the magnitude of their combined injuries and the degree of physiological insult, DCS salvaged 45 % of critically injured patients who later underwent definitive pancreatic surgery. Mortality correlated with associated vascular injuries overall, major visceral venous injuries and the combination of vascular plus the total number of associated organs injured.

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Author information

Authors and Affiliations

  1. Department of Surgery, University of Cape Town Health Sciences Faculty, Anzio Road, Observatory, Cape Town, 7925, South Africa

    J. E. J. Krige, U. K. Kotze, A. J. Nicol & P. H. Navsaria

  2. Department of Medicine, University of Cape Town Health Sciences Faculty, Groote Schuur Hospital, Observatory, Cape Town, South Africa

    M. Setshedi

  3. Surgical Gastroenterology Unit, Groote Schuur Hospital, Observatory, Cape Town, South Africa

    J. E. J. Krige & U. K. Kotze

  4. Trauma Centre, Groote Schuur Hospital, Observatory, Cape Town, South Africa

    A. J. Nicol & P. H. Navsaria

Authors
  1. J. E. J. Krige
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  2. U. K. Kotze
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  3. M. Setshedi
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  4. A. J. Nicol
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  5. P. H. Navsaria
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Corresponding author

Correspondence to J. E. J. Krige.

Ethics declarations

This study was approved by the Human Research Ethics Committee at the University of Cape Town Health Sciences Faculty. The study conforms to the ethical standards in the 1964 Declaration of Helsinki, and adheres to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines.

Conflict of interest

J E. Krige, U. K. Kotze, M. Setshedi, P. H. Navsaria and A. J. Nicol declare that they have no conflict of interest.

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Krige, J.E.J., Kotze, U.K., Setshedi, M. et al. Management of pancreatic injuries during damage control surgery: an observational outcomes analysis of 79 patients treated at an academic Level 1 trauma centre. Eur J Trauma Emerg Surg 43, 411–420 (2017). https://doi.org/10.1007/s00068-016-0657-6

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  • DOI: https://doi.org/10.1007/s00068-016-0657-6

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