The consequences of major visceral vascular injuries on outcome in patients with pancreatic injuries: a case-matched analysis

  • J E J Krige University of Cape Town
  • E Jonas University of Cape Town
  • U Kotze University of Cape Town
  • M Setshedi University of Cape Town
  • P H Navsaria University of Cape Town
  • A J Nicol University of Cape Town
Keywords: pancreas, vascular, injury

Abstract

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: A registered prospective database of 461 consecutive patients with pancreatic injuries was used to identify 68 patients with a Pancreatic Injury combined with a major visceral Vascular Injury (PIVI group) and were matched one-to-one by an independent blinded reviewer using a validated individual matching method to 68 similar Pancreatic Injury patients without a vascular injury (PI group). The two groups were compared using univariate and multivariate logistic regression analysis and outcome including complication rates, length of hospital stay and 90-day mortality rate was measured.

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: 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.

Author Biographies

J E J Krige, University of Cape Town

Department of Surgery, Faculty of Health Sciences, University of Cape Town and Surgical Gastroenterology and HPB Unit, Faculty of Health Sciences, University of Cape Town, South Africa

E Jonas, University of Cape Town

Department of Surgery, Faculty of Health Sciences, University of Cape Town and Surgical Gastroenterology and HPB Unit, Faculty of Health Sciences, University of Cape Town, South Africa

U Kotze, University of Cape Town

Department of Surgery, Faculty of Health Sciences, University of Cape Town and Surgical Gastroenterology and HPB Unit, Faculty of Health Sciences, University of Cape Town, South Africa

M Setshedi, University of Cape Town

Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

P H Navsaria, University of Cape Town

Department of Surgery, Faculty of Health Sciences, University of Cape Town and Trauma Centre, Groote Schuur Hospital, Cape Town, South Africa

A J Nicol, University of Cape Town

Department of Surgery, Faculty of Health Sciences, University of Cape Town and Trauma Centre, Groote Schuur Hospital, Cape Town, South Africa

Published
2019-06-27
How to Cite
Krige, J., Jonas, E., Kotze, U., Setshedi, M., Navsaria, P., & Nicol, A. (2019). The consequences of major visceral vascular injuries on outcome in patients with pancreatic injuries: a case-matched analysis. South African Journal of Surgery, 57(3), 30-37. Retrieved from http://sajs.redbricklibrary.com/index.php/sajs/article/view/3000
Section
Trauma