University of Massachusetts Medical School Faculty Publications


National trends in pancreaticoduodenal trauma: interventions and outcomes

UMMS Affiliation

Department of Surgery

Publication Date


Document Type



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.


UMCCTS funding

DOI of Published Version



HPB (Oxford). 2014 Mar;16(3):275-81. doi: 10.1111/hpb.12125. Epub 2013 Jul 22. Link to article on publisher's site

Related Resources

Link to Article in PubMed

Journal/Book/Conference Title

HPB : the official journal of the International Hepato Pancreato Biliary Association

PubMed ID