The consequences of major visceral vascular injuries on outcome in patients with pancreatic injuries: a case-matched analysis.
Abdominal Injuries
/ complications
Adolescent
Adult
Aged
Aorta
/ injuries
Blood Transfusion
Case-Control Studies
Female
Humans
Length of Stay
Male
Mesenteric Artery, Superior
/ injuries
Middle Aged
Pancreas
/ injuries
Portal System
/ injuries
Postoperative Complications
/ etiology
Renal Artery
/ injuries
Renal Veins
/ injuries
Shock
/ etiology
Splenic Artery
/ injuries
Survival Rate
Trauma Severity Indices
Vascular System Injuries
/ complications
Vena Cava, Inferior
/ injuries
Young Adult
Journal
South African journal of surgery. Suid-Afrikaanse tydskrif vir chirurgie
ISSN: 2078-5151
Titre abrégé: S Afr J Surg
Pays: South Africa
ID NLM: 2984854R
Informations de publication
Date de publication:
Sep 2019
Sep 2019
Historique:
entrez:
9
8
2019
pubmed:
9
8
2019
medline:
30
1
2020
Statut:
ppublish
Résumé
Major pancreatic injuries are complex to treat, especially when combined with vascular and other critical organ injuries. This case-matched analysis assessed the influence of associated visceral vascular injuries on outcome in pancreatic injuries. A registered prospective database of 461 consecutive patients with pancreatic injuries was used to identify 68 patients with a The two groups were well matched according to surgical intervention. Mortality in the PIVI group was 41% (n = 28) compared to 13% (n = 9) in the PI alone group (p = 0.000, OR 4.5, CI 1.00-10.5). On univariate analysis the PIVI group was significantly more likely to (i) be shocked on admission, (ii) have a RTS < 7.8, (iii) require damage control laparotomy, (iv) require a blood transfusion, both in frequency and volume, (v) develop a major postoperative complication and (vi) die. On multivariate analysis, the need for damage control laparotomy was a significant variable (p = 0.015, OR 7.95, CI 1.50-42.0) for mortality. Mortality of AAST grade 1 and 2 pancreatic injuries combined with a vascular injury was 18.5% (5/27) compared to an increased mortality of 56.1% (23/41) of AAST grade 3, 4 and 5 pancreatic injuries with vascular injuries (p = 0.0026). This study confirms that pancreatic injuries associated with major visceral vascular injuries have a significantly higher complication and mortality rate than pancreatic injuries without vascular injuries and that the addition of a vascular injury with an increasing AAST grade of pancreatic injury exponentially compounds the mortality rate.
Sections du résumé
BACKGROUND
BACKGROUND
Major pancreatic injuries are complex to treat, especially when combined with vascular and other critical organ injuries. This case-matched analysis assessed the influence of associated visceral vascular injuries on outcome in pancreatic injuries.
METHOD
METHODS
A registered prospective database of 461 consecutive patients with pancreatic injuries was used to identify 68 patients with a
RESULTS
RESULTS
The two groups were well matched according to surgical intervention. Mortality in the PIVI group was 41% (n = 28) compared to 13% (n = 9) in the PI alone group (p = 0.000, OR 4.5, CI 1.00-10.5). On univariate analysis the PIVI group was significantly more likely to (i) be shocked on admission, (ii) have a RTS < 7.8, (iii) require damage control laparotomy, (iv) require a blood transfusion, both in frequency and volume, (v) develop a major postoperative complication and (vi) die. On multivariate analysis, the need for damage control laparotomy was a significant variable (p = 0.015, OR 7.95, CI 1.50-42.0) for mortality. Mortality of AAST grade 1 and 2 pancreatic injuries combined with a vascular injury was 18.5% (5/27) compared to an increased mortality of 56.1% (23/41) of AAST grade 3, 4 and 5 pancreatic injuries with vascular injuries (p = 0.0026).
CONCLUSION
CONCLUSIONS
This study confirms that pancreatic injuries associated with major visceral vascular injuries have a significantly higher complication and mortality rate than pancreatic injuries without vascular injuries and that the addition of a vascular injury with an increasing AAST grade of pancreatic injury exponentially compounds the mortality rate.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
30-37Informations de copyright
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