Trauma Surgery & Acute Care Open (Nov 2024)
Pancreaticoduodenectomy in trauma patients with grade IV–V duodenal or pancreatic injuries: a post hoc analysis of an EAST multicenter trial
- Jeffry Nahmias,
- Daniel N Holena,
- Bellal Joseph,
- Martin Schreiber,
- Lisa M Kodadek,
- Mayur Narayan,
- Grace Chang,
- Joe Patton,
- Abid Khan,
- Mark Seamon,
- Jessica H Beard,
- Michelle T Bover Manderski,
- Michael A Vella,
- Ryan Peter Dumas,
- Haytham Kaafarani,
- Alison A Smith,
- Rachel Leah Choron,
- Christopher Bargoud,
- Amanda L Teichman,
- Francesk Mulita,
- Christine T Trankiem,
- Hashim Ahmed,
- Aaron Anderson,
- Odessa Pulido,
- Caleb Mentzer,
- Jane Keating,
- Mira Ghneim,
- Reynold Henry,
- Dane R Scantling,
- Andrew Benjamin,
- Christopher W Foote,
- Carlos H Palacio,
- Randi N Smith,
- Meghan Jonikas,
- Dias Argandykov,
- Jason D Sciarretta,
- Joshua P Hazelton,
- Pascal Udekwu,
- Jordan Michael Kirsch,
- Charoo Piplani,
- Julia Kuzinar,
- Dustin Hanos,
- Iman N Afif,
- Navpreet Kaur Dhillon,
- Ashling Zhang,
- Rebekah Devasahayam,
- Oliver Gunter,
- Brandi Sun,
- Chloe S Cao,
- Jessica K Reynolds,
- Lauren A Hilt,
- Karla Echeverria-Rosario,
- Nathaniel S Fung,
- Caitlin A Fitzgerald,
- Jeremy H Levin,
- JaeHee Yoon,
- Jacqueline Blank,
- Christopher J McLaughlin,
- Rami Al-Aref,
- Daniel S Howard,
- Kate Dellonte,
- Brent Hopkins,
- Chloe Shell,
- Evan G Wong,
- Howard Lieberman,
- Walter A Ramsey,
- Collin H Stewart,
- Claudia Alvarez,
- John D Berne,
- Ivan Puente,
- Ilya Rakitin,
- Lindsey Perea,
- Jason Wade,
- Laura K Mann,
- Vasileios Mousafeiris,
- Shari Reid-Gruner,
- Erica Sais,
- Lilamarie Moko
Affiliations
- Jeffry Nahmias
- University of California Irvine School of Medicine, Irvine, California, USA
- Daniel N Holena
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Bellal Joseph
- The University of Arizona College of Medicine Tucson, Tucson, Arizona, USA
- Martin Schreiber
- Surgery, Oregon Health and Science University, Portland, Oregon, USA
- Lisa M Kodadek
- Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
- Mayur Narayan
- Surgery, Division of Acute Care Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
- Grace Chang
- Surgery, Mount Sinai Hospital, Chicago, Illinois, USA
- Joe Patton
- Surgery, Henry Ford Hospital, Detroit, Michigan, USA
- Abid Khan
- The University of Chicago Medicine, Chicago, Illinois, USA
- Mark Seamon
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Jessica H Beard
- Surgery, Temple University, Philadelphia, Pennsylvania, USA
- Michelle T Bover Manderski
- Rutgers School of Public Health, Piscataway, New Jersey, USA
- Michael A Vella
- Surgery, University of Rochester Medical Center, Rochester, New York, USA
- Ryan Peter Dumas
- UT Southwestern Medical, Dallas, Texas, USA
- Haytham Kaafarani
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Alison A Smith
- Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
- Rachel Leah Choron
- Surgery, Division of Acute Care Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
- Christopher Bargoud
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
- Amanda L Teichman
- Surgery, Division of Acute Care Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
- Francesk Mulita
- University General Hospital of Patras, Patra, Greece
- Christine T Trankiem
- MedStar Washington Hospital Center, Washington, District of Columbia, USA
- Hashim Ahmed
- Surgery, Texas Health Harris Methodist Hospital Fort Worth, Fort Worth, Texas, USA
- Aaron Anderson
- Indiana University Health Methodist Hospital, Indianapolis, Indiana, USA
- Odessa Pulido
- Lancaster General Health, Lancaster, Pennsylvania, USA
- Caleb Mentzer
- Department of Surgery, University of Texas McGovern Medical School, Houston, Texas, USA
- Jane Keating
- Hartford Hospital, Hartford, Connecticut, USA
- Mira Ghneim
- R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA
- Reynold Henry
- Oregon Health & Science University, Portland, Oregon, USA
- Dane R Scantling
- Boston Medical Center, Boston, Massachusetts, USA
- Andrew Benjamin
- The University of Chicago Medicine, Chicago, Illinois, USA
- Christopher W Foote
- Trauma Services Department, South Texas Health System, McAllen, Texas, USA
- Carlos H Palacio
- South Texas Health System, Edinburg, Texas, USA
- Randi N Smith
- Trauma/Surgical Critical Care, Emory University School of Medicine, Atlanta, Georgia, USA
- Meghan Jonikas
- Department of Surgery, Mount Sinai Hospital, Chicago, Illinois, USA
- Dias Argandykov
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Jason D Sciarretta
- Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
- Joshua P Hazelton
- WellSpan Health, York, Pennsylvania, USA
- Pascal Udekwu
- Surgery, WakeMed Health and Hospitals, Raleigh, North Carolina, USA
- Jordan Michael Kirsch
- Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
- Charoo Piplani
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
- Julia Kuzinar
- Surgery, Division of Acute Care Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
- Dustin Hanos
- Grady Memorial Hospital Corp, Atlanta, Georgia, USA
- Iman N Afif
- Temple University Hospital, Philadelphia, Pennsylvania, USA
- Navpreet Kaur Dhillon
- R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA
- Ashling Zhang
- University of Maryland School of Medicine, Baltimore, Maryland, USA
- Rebekah Devasahayam
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Oliver Gunter
- Trauma/Surgical Critical Care, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Brandi Sun
- Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
- Chloe S Cao
- University of Kentucky, Lexington, Kentucky, USA
- Jessica K Reynolds
- University of Kentucky, Lexington, Kentucky, USA
- Lauren A Hilt
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Karla Echeverria-Rosario
- Cooper University Hospital Regional Trauma Center, Camden, New Jersey, USA
- Nathaniel S Fung
- Riverside University Health System Medical Center, Moreno Valley, California, USA
- Caitlin A Fitzgerald
- The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Jeremy H Levin
- Indiana University Health Methodist Hospital, Indianapolis, Indiana, USA
- JaeHee Yoon
- MedStar Washington Hospital Center, Washington, District of Columbia, USA
- Jacqueline Blank
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Christopher J McLaughlin
- Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
- Rami Al-Aref
- Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
- Daniel S Howard
- Boston Medical Center, Boston, Massachusetts, USA
- Kate Dellonte
- University of Rochester, Rochester, New York, USA
- Brent Hopkins
- McGill University, Montreal, Quebec, Canada
- Chloe Shell
- WakeMed Health and Hospitals, Raleigh, North Carolina, USA
- Evan G Wong
- McGill University, Montreal, Quebec, Canada
- Howard Lieberman
- Jackson Memorial Hospital, Miami, Florida, USA
- Walter A Ramsey
- Jackson Memorial Hospital, Miami, Florida, USA
- Collin H Stewart
- University of Arizona Medical Center - University Campus, Tucson, Arizona, USA
- Claudia Alvarez
- University of California Irvine School of Medicine, Irvine, California, USA
- John D Berne
- Broward Health Medical Center, Fort Lauderdale, Florida, USA
- Ivan Puente
- Broward Health Medical Center, Fort Lauderdale, Florida, USA
- Ilya Rakitin
- Henry Ford Hospital, Detroit, Michigan, USA
- Lindsey Perea
- Lancaster General Health, Lancaster, Pennsylvania, USA
- Jason Wade
- Hartford Hospital, Hartford, Connecticut, USA
- Laura K Mann
- Spartanburg Regional Medical Center, Spartanburg, South Carolina, USA
- Vasileios Mousafeiris
- University General Hospital of Patras, Patra, Greece
- Shari Reid-Gruner
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
- Erica Sais
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
- Lilamarie Moko
- Surgery, Division of Acute Care Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
- DOI
- https://doi.org/10.1136/tsaco-2024-001438
- Journal volume & issue
-
Vol. 9,
no. 1
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.
