J E J Krige1, U K Kotze2, M Setshedi3, A J Nicol4, P H Navsaria4. 1. Department of Surgery, University of Cape Town, Health Sciences Faculty, Groote Schuur Hospital, Observatory, Cape Town, South Africa; Surgical Gastroenterology Unit, Groote Schuur Hospital, Observatory, Cape Town, South Africa. Electronic address: jej.krige@uct.ac.za. 2. Department of Surgery, University of Cape Town, Health Sciences Faculty, Groote Schuur Hospital, Observatory, Cape Town, South Africa; Surgical Gastroenterology Unit, Groote Schuur Hospital, Observatory, Cape Town, South Africa. 3. Department of Medicine, University of Cape Town, Health Sciences Faculty, Groote Schuur Hospital, Observatory, Cape Town, South Africa. 4. Department of Surgery, University of Cape Town, Health Sciences Faculty, Groote Schuur Hospital, Observatory, Cape Town, South Africa; Trauma Centre, Groote Schuur Hospital, Observatory, Cape Town, South Africa.
Abstract
BACKGROUND: This large retrospective observational cohort study evaluated prognostic factors, 30-day morbidity and mortality and complications related to the pancreas in patients who had sustained pancreatic injuries. METHODS: The records of 432 consecutive patients treated for pancreatic injuries at an urban Level 1 Trauma Centre in Cape Town between January 1982 and December 2012 were reviewed. Primary endpoints were postoperative morbidity and death. Bivariate and multivariate logistic regression analyses were used to assess significant predictors of morbidity and mortality. RESULTS: Overall mortality in 432 patients [394 men, median age 26, median RTS 7.8] was 15.7% and morbidity 66%. Bivariate logistic regression analysis showed that nine factors, age, RTS, presence of shock, need for a transfusion, volume of blood transfused, damage control surgery, AAST grade of pancreatic injury, an associated vascular injury and a repeat laparotomy were significant predictors of morbidity. In the final multivariate logistic regression analysis model however only two variables, AAST grade of pancreatic injury and a repeat laparotomy were significant predictors of morbidity. When factors associated with mortality were considered, logistic regression analysis found that 11 variables, age, RTS, the presence of shock, patients who required a major blood transfusion, the median number of units transfused, the need for a damage control laparotomy, AAST grade 3, 4, 5 pancreatic injuries, associated vascular injuries, the number of associated injuries, postoperative complications and days in ICU were significant. However in the final stepwise multivariate logistic regression analysis model only five variables, age, shock, median number of units transfused and the presence of associated complications were significant factors associated with mortality. CONCLUSIONS: Morbidity was 64% and AAST grade of pancreatic injury and a repeat laparotomy were significant predictors of morbidity. Overall mortality was 15.7%. Most deaths were due to associated injuries and were unrelated to the pancreatic injury. Five variables, age, shock, median number of units transfused and the presence of associated complications were significant factors associated with mortality. These data indicate that the magnitude of blood loss and haemorrhagic shock are primary determinants for survival and that urgent reversal of shock and control of bleeding are essential to reduce mortality in this cohort of patients.
BACKGROUND: This large retrospective observational cohort study evaluated prognostic factors, 30-day morbidity and mortality and complications related to the pancreas in patients who had sustained pancreatic injuries. METHODS: The records of 432 consecutive patients treated for pancreatic injuries at an urban Level 1 Trauma Centre in Cape Town between January 1982 and December 2012 were reviewed. Primary endpoints were postoperative morbidity and death. Bivariate and multivariate logistic regression analyses were used to assess significant predictors of morbidity and mortality. RESULTS: Overall mortality in 432 patients [394 men, median age 26, median RTS 7.8] was 15.7% and morbidity 66%. Bivariate logistic regression analysis showed that nine factors, age, RTS, presence of shock, need for a transfusion, volume of blood transfused, damage control surgery, AAST grade of pancreatic injury, an associated vascular injury and a repeat laparotomy were significant predictors of morbidity. In the final multivariate logistic regression analysis model however only two variables, AAST grade of pancreatic injury and a repeat laparotomy were significant predictors of morbidity. When factors associated with mortality were considered, logistic regression analysis found that 11 variables, age, RTS, the presence of shock, patients who required a major blood transfusion, the median number of units transfused, the need for a damage control laparotomy, AAST grade 3, 4, 5 pancreatic injuries, associated vascular injuries, the number of associated injuries, postoperative complications and days in ICU were significant. However in the final stepwise multivariate logistic regression analysis model only five variables, age, shock, median number of units transfused and the presence of associated complications were significant factors associated with mortality. CONCLUSIONS: Morbidity was 64% and AAST grade of pancreatic injury and a repeat laparotomy were significant predictors of morbidity. Overall mortality was 15.7%. Most deaths were due to associated injuries and were unrelated to the pancreatic injury. Five variables, age, shock, median number of units transfused and the presence of associated complications were significant factors associated with mortality. These data indicate that the magnitude of blood loss and haemorrhagic shock are primary determinants for survival and that urgent reversal of shock and control of bleeding are essential to reduce mortality in this cohort of patients.
Authors: Noah S Rozich; Katherine T Morris; Tabitha Garwe; Zoona Sarwar; Alessandra Landmann; Chesney B Siems; Alexandra Jones; Casey S Butler; Paul K McGaha; Benjamin C Axtman; Barish H Edil; Jason S Lees Journal: J Trauma Acute Care Surg Date: 2019-12 Impact factor: 3.697
Authors: Jake E Krige; Eduard Jonas; Sandie R Thomson; Urda K Kotze; Mashiko Setshedi; Pradeep H Navsaria; Andrew J Nicol Journal: World J Gastrointest Surg Date: 2017-03-27
Authors: Nadja Benmohamed; Ziad Abbassi; Surennaidoo P Naiken; Philippe Morel; Alexandra Platon; Pierre-Alexandre Poletti; Christian Toso Journal: J Surg Case Rep Date: 2016-12-31
Authors: Federico Coccolini; Leslie Kobayashi; Yoram Kluger; Ernest E Moore; Luca Ansaloni; Walt Biffl; Ari Leppaniemi; Goran Augustin; Viktor Reva; Imitiaz Wani; Andrew Kirkpatrick; Fikri Abu-Zidan; Enrico Cicuttin; Gustavo Pereira Fraga; Carlos Ordonez; Emmanuil Pikoulis; Maria Grazia Sibilla; Ron Maier; Yosuke Matsumura; Peter T Masiakos; Vladimir Khokha; Alain Chichom Mefire; Rao Ivatury; Francesco Favi; Vassil Manchev; Massimo Sartelli; Fernando Machado; Junichi Matsumoto; Massimo Chiarugi; Catherine Arvieux; Fausto Catena; Raul Coimbra Journal: World J Emerg Surg Date: 2019-12-11 Impact factor: 5.469