Mortality patterns and postoperative outcomes of trauma-induced pancreatic resections: A pilot study

BACKGROUND: Pancreatic surgery is one of the most challenging and complex types of surgery. Mortality rates for trauma-induced resective pancreatic surgery are higher than those for elective pancreatic surgical procedures. Factors that increase mortality due to high-energy trauma include additional organ damage and hypovolemic shock, and complications of resective surgery can also be considered. There are few studies on this in the literature. This study aims to analyze resective pancreatic surgery outcomes and mortality patterns at a tertiary high-volume trauma and hepatobiliary surgery center.
METHODS: Patients who underwent resection due to pancreatic trauma between 2019 and 2024 were retrospectively reviewed. Preoperative clinical findings, laboratory tests, and radiologic images were evaluated, and trauma scores were calculated. The surgeries, as well as postoperative morbidities and mortalities, were examined. Mortality within the first three days postoperatively was considered early, while mortality occurring thereafter was classified as late operative mortality.
RESULTS: According to the American Association for the Surgery of Trauma grading, 10 patients (55.5%) had Grade 4–5 blunt trauma, and 4 patients (22.2%) each had Grade 3 blunt trauma and Grade 4–5 penetrating trauma. Furthermore, 7 of the operated patients (38.88%) had fatal outcomes. The mortality rates were 57.14% for hemorrhagic shock-related deaths, 14.28% for pancreatic fistula-related deaths, and 28.56% for deaths unrelated to pancreatic fistulas.
CONCLUSION: In our study, early mortality was particularly high in patients presenting with shock from vascular injury, while late-term mortality was due to sepsis from pancreatic fistula and other complications. Effective management of shock at the time of arrival and postoperative complication management can help reduce morbidity and mortality in trauma-related pancreatic resections.

Travma nedenli pankreas rezeksiyonu yapýlan hastalarýn postoperatif sonuçlarý ve mortalite paternleri: Pilot çalýþma

AMAÇ: Pankreas cerrahisi zor bir cerrahidir ve acil ameliyatlar elektif cerrahilere kýyasla daha yüksek mortalite oranlarýna sahiptir. Hemorajik þok, ek organ hasarý ve rezektif cerrahinin komplikasyonlarý, mortaliteyi artýran faktörlerdir. Bu çalýþma, yüksek hacimli travma ve hepatobiliyer cerrahi merkezinde pankreas travmasýna baðlý rezektif cerrahilerin sonuçlarýný ve mortalite paternlerini analiz etmeyi amaçlamaktadýr.
GEREÇ VE YÖNTEM: Þubat 2019-Mart 2024 yýllarý arasýnda pankreas travmasý nedeniyle rezeksiyon yapýlan hastalar retrospektif olarak incelenmiþtir. Preoperatif klinik veriler, laboratuvar testleri ve radyolojik görüntüler deðerlendirilmiþ ve travma skorlama yapýlmýþtýr. Cerrahi sonuçlar, postoperatif morbiditeler ve mortaliteler incelenmiþtir. Erken mortalite, postoperatif ilk üç gün içinde gerçekleþen ölümler olarak tanýmlanmýþ, geç mortalite ise sonrasýndaki ölümler olarak sýnýflandýrýlmýþtýr.
BULGULAR: Amerikan Travma Cerrahisi Derneðinin derecelendirmesine göre, 10 hasta (%55.5) Grade 4-5 travma, 4 hasta (%22.2) Grade 3 travma, 4 hasta (%22.2) ise Grade 4-5 penetran travma geçirdi. Operasyon geçiren hastalarýn 7'si (%38.88) mortal seyretti. Mortalite oranlarý; hemorajik þokla iliþkili ölümler %57.14, pankreatik fistül kaynaklý ölümler %14.28 ve pankreatik fistüllerle iliþkili olmayan ölümler %28.56 olarak saptandý. SONUÇ: Çalýþmamýzda, vasküler yaralanmadan kaynaklanan þok ile baþvuran hastalarda erken mortalite özellikle yüksektir, geç dönem mortalite ise pankreatik fistül ve diðer komplikasyonlara baðlýdýr. Gelen hastalarda þok yönetiminin etkin bir þekilde yapýlmasý ve postoperatif komplikasyonlarýn yönetilmesi, travma kaynaklý pankreas rezeksiyonlarýnda morbidite ve mortaliteyi azaltmada yardýmcý olabilir.