Pancreaticoduodenectomy in trauma patients with grade IV–V duodenal or pancreatic injuries: a post hoc analysis of an EAST multicenter trial
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.M...
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2024-11-01
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| author | 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 |
| author_facet | 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 |
| author_sort | Jeffry Nahmias |
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| description | 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. |
| format | Article |
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| institution | OA Journals |
| issn | 2397-5776 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Trauma Surgery & Acute Care Open |
| spelling | doaj-art-219801c299f9469f9e694138616bc01f2025-08-20T02:27:06ZengBMJ Publishing GroupTrauma Surgery & Acute Care Open2397-57762024-11-019110.1136/tsaco-2024-001438Pancreaticoduodenectomy in trauma patients with grade IV–V duodenal or pancreatic injuries: a post hoc analysis of an EAST multicenter trialJeffry Nahmias0Daniel N Holena1Bellal Joseph2Martin Schreiber3Lisa M Kodadek4Mayur Narayan5Grace Chang6Joe Patton7Abid Khan8Mark Seamon9Jessica H Beard10Michelle T Bover Manderski11Michael A Vella12Ryan Peter Dumas13Haytham Kaafarani14Alison A Smith15Rachel Leah Choron16Christopher Bargoud17Amanda L Teichman18Francesk Mulita19Christine T Trankiem20Hashim Ahmed21Aaron Anderson22Odessa Pulido23Caleb Mentzer24Jane Keating25Mira Ghneim26Reynold Henry27Dane R Scantling28Andrew Benjamin29Christopher W Foote30Carlos H Palacio31Randi N Smith32Meghan Jonikas33Dias Argandykov34Jason D Sciarretta35Joshua P Hazelton36Pascal Udekwu37Jordan Michael Kirsch38Charoo Piplani39Julia Kuzinar40Dustin Hanos41Iman N Afif42Navpreet Kaur Dhillon43Ashling Zhang44Rebekah Devasahayam45Oliver Gunter46Brandi Sun47Chloe S Cao48Jessica K Reynolds49Lauren A Hilt50Karla Echeverria-Rosario51Nathaniel S Fung52Caitlin A Fitzgerald53Jeremy H Levin54JaeHee Yoon55Jacqueline Blank56Christopher J McLaughlin57Rami Al-Aref58Daniel S Howard59Kate Dellonte60Brent Hopkins61Chloe Shell62Evan G Wong63Howard Lieberman64Walter A Ramsey65Collin H Stewart66Claudia Alvarez67John D Berne68Ivan Puente69Ilya Rakitin70Lindsey Perea71Jason Wade72Laura K Mann73Vasileios Mousafeiris74Shari Reid-Gruner75Erica Sais76Lilamarie Moko77University of California Irvine School of Medicine, Irvine, California, USAMedical College of Wisconsin, Milwaukee, Wisconsin, USAThe University of Arizona College of Medicine Tucson, Tucson, Arizona, USASurgery, Oregon Health and Science University, Portland, Oregon, USASurgery, Yale University School of Medicine, New Haven, Connecticut, USASurgery, Division of Acute Care Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USASurgery, Mount Sinai Hospital, Chicago, Illinois, USASurgery, Henry Ford Hospital, Detroit, Michigan, USAThe University of Chicago Medicine, Chicago, Illinois, USAUniversity of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USASurgery, Temple University, Philadelphia, Pennsylvania, USARutgers School of Public Health, Piscataway, New Jersey, USASurgery, University of Rochester Medical Center, Rochester, New York, USAUT Southwestern Medical, Dallas, Texas, USAMassachusetts General Hospital, Boston, Massachusetts, USALouisiana State University Health Sciences Center, New Orleans, Louisiana, USASurgery, Division of Acute Care Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USARutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USASurgery, Division of Acute Care Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USAUniversity General Hospital of Patras, Patra, GreeceMedStar Washington Hospital Center, Washington, District of Columbia, USASurgery, Texas Health Harris Methodist Hospital Fort Worth, Fort Worth, Texas, USAIndiana University Health Methodist Hospital, Indianapolis, Indiana, USALancaster General Health, Lancaster, Pennsylvania, USADepartment of Surgery, University of Texas McGovern Medical School, Houston, Texas, USAHartford Hospital, Hartford, Connecticut, USAR Adams Cowley Shock Trauma Center, Baltimore, Maryland, USAOregon Health & Science University, Portland, Oregon, USABoston Medical Center, Boston, Massachusetts, USAThe University of Chicago Medicine, Chicago, Illinois, USATrauma Services Department, South Texas Health System, McAllen, Texas, USASouth Texas Health System, Edinburg, Texas, USATrauma/Surgical Critical Care, Emory University School of Medicine, Atlanta, Georgia, USADepartment of Surgery, Mount Sinai Hospital, Chicago, Illinois, USAMassachusetts General Hospital, Boston, Massachusetts, USASurgery, Emory University School of Medicine, Atlanta, Georgia, USAWellSpan Health, York, Pennsylvania, USASurgery, WakeMed Health and Hospitals, Raleigh, North Carolina, USAWashington University School of Medicine in Saint Louis, St Louis, Missouri, USARutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USASurgery, Division of Acute Care Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USAGrady Memorial Hospital Corp, Atlanta, Georgia, USATemple University Hospital, Philadelphia, Pennsylvania, USAR Adams Cowley Shock Trauma Center, Baltimore, Maryland, USAUniversity of Maryland School of Medicine, Baltimore, Maryland, USAVanderbilt University Medical Center, Nashville, Tennessee, USATrauma/Surgical Critical Care, Vanderbilt University School of Medicine, Nashville, Tennessee, USALouisiana State University Health Sciences Center, New Orleans, Louisiana, USAUniversity of Kentucky, Lexington, Kentucky, USAUniversity of Kentucky, Lexington, Kentucky, USAMedical College of Wisconsin, Milwaukee, Wisconsin, USACooper University Hospital Regional Trauma Center, Camden, New Jersey, USARiverside University Health System Medical Center, Moreno Valley, California, USAThe University of Texas Southwestern Medical Center, Dallas, Texas, USAIndiana University Health Methodist Hospital, Indianapolis, Indiana, USAMedStar Washington Hospital Center, Washington, District of Columbia, USAUniversity of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USAPenn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USAWashington University School of Medicine in Saint Louis, St Louis, Missouri, USABoston Medical Center, Boston, Massachusetts, USAUniversity of Rochester, Rochester, New York, USAMcGill University, Montreal, Quebec, CanadaWakeMed Health and Hospitals, Raleigh, North Carolina, USAMcGill University, Montreal, Quebec, CanadaJackson Memorial Hospital, Miami, Florida, USAJackson Memorial Hospital, Miami, Florida, USAUniversity of Arizona Medical Center - University Campus, Tucson, Arizona, USAUniversity of California Irvine School of Medicine, Irvine, California, USABroward Health Medical Center, Fort Lauderdale, Florida, USABroward Health Medical Center, Fort Lauderdale, Florida, USAHenry Ford Hospital, Detroit, Michigan, USALancaster General Health, Lancaster, Pennsylvania, USAHartford Hospital, Hartford, Connecticut, USASpartanburg Regional Medical Center, Spartanburg, South Carolina, USAUniversity General Hospital of Patras, Patra, GreeceThomas Jefferson University Hospital, Philadelphia, Pennsylvania, USAThomas Jefferson University Hospital, Philadelphia, Pennsylvania, USASurgery, Division of Acute Care Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USAIntroduction 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.https://tsaco.bmj.com/content/9/1/e001438.full |
| spellingShingle | 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 Pancreaticoduodenectomy in trauma patients with grade IV–V duodenal or pancreatic injuries: a post hoc analysis of an EAST multicenter trial Trauma Surgery & Acute Care Open |
| title | Pancreaticoduodenectomy in trauma patients with grade IV–V duodenal or pancreatic injuries: a post hoc analysis of an EAST multicenter trial |
| title_full | Pancreaticoduodenectomy in trauma patients with grade IV–V duodenal or pancreatic injuries: a post hoc analysis of an EAST multicenter trial |
| title_fullStr | Pancreaticoduodenectomy in trauma patients with grade IV–V duodenal or pancreatic injuries: a post hoc analysis of an EAST multicenter trial |
| title_full_unstemmed | Pancreaticoduodenectomy in trauma patients with grade IV–V duodenal or pancreatic injuries: a post hoc analysis of an EAST multicenter trial |
| title_short | Pancreaticoduodenectomy in trauma patients with grade IV–V duodenal or pancreatic injuries: a post hoc analysis of an EAST multicenter trial |
| title_sort | pancreaticoduodenectomy in trauma patients with grade iv v duodenal or pancreatic injuries a post hoc analysis of an east multicenter trial |
| url | https://tsaco.bmj.com/content/9/1/e001438.full |
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