National trends in pancreaticoduodenal trauma: interventions and outcomes
Department of Surgery
Medical Subject Headings
Adult; Chi-Square Distribution; Digestive System Surgical Procedures; Duodenum; Female; Gastroenterology; Humans; Length of Stay; Linear Models; Logistic Models; Male; Multivariate Analysis; Odds Ratio; Pancreas; Postoperative Complications; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; United States; Wounds and Injuries
Clinical Epidemiology | Gastroenterology | Health Services Research | Surgery
OBJECTIVES: Pancreaticoduodenal trauma (PDT) is associated with substantial mortality and morbidity. In this study, contemporary trends were analysed using national data.
METHODS: The Nationwide Inpatient Sample for 1998-2009 was queried for patients with PDT. Interventions including any operation (Any-Op) and pancreas-specific surgery (PSURG) were identified. Trends in treatment and outcomes were determined [complications, length of stay (LoS), mortality] for the Any-Op, PSURG and non-operative (Non-Op) groups. Analyses included chi-squared tests, Cochran-Armitage trend tests and logistic regression.
RESULTS: A total of 27 216 patients (nationally weighted) with PDT were identified. Over time, the frequency of PDT increased by 8.3%, whereas the proportion of patients submitted to PSURG declined (from 21.7% to 19.8%; P = 0.0004) and the percentage of patients submitted to non-operative management increased (from 56.7% to 59.1%; P = 0.01). In the Non-Op group, mortality decreased from 9.7% to 8.6% (P < 0.001); morbidity and LoS remained unchanged at approximately 40% and approximately 12 days, respectively. In the PSURG group, mortality remained stable at approximately 15%, complications increased from 50.2% to 71.8% (P < 0.0001) and LoS remained stable at approximately 21 days. For all PDT patients, significant independent predictors of mortality included: the presence of combined pancreatic and duodenal injuries; penetrating trauma, and age over 50 years. Having any operation (Any-Op) was associated with mortality, but PSURG was not a predictor of death.
CONCLUSIONS: The utilization of operations for PDT has declined without affecting mortality, but operative morbidity increased significantly over the 12 years to 2009. The development of an evidence-based approach to invasive manoeuvres and an early multidisciplinary approach involving pancreatic surgeons may improve outcomes in patients with these morbid injuries.
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Citation: HPB (Oxford). 2014 Mar;16(3):275-81. doi: 10.1111/hpb.12125. Epub 2013 Jul 22. Link to article on publisher's site
Ragulin-Coyne, Elizaveta; Witkowski, Elan R.; Chau, Zeling; Wemple, Daniel; Ng, Sing Chau; Santry, Heena P.; Shah, Shimul A.; and Tseng, Jennifer F., "National trends in pancreaticoduodenal trauma: interventions and outcomes" (2014). University of Massachusetts Medical School Faculty Publications. 476.